Beth C. Weitzman

Predictors of homelessness among families in New York City: from shelter request to housing stability.

OBJECTIVES This study examined predictors of entry into shelter and subsequent housing stability for a cohort of families receiving public assistance in New York City. METHODS Interviews were conducted with 266 families as they requested shelter and with a comparison sample of 298 families selected at random from the welfare caseload. Respondents were reinterviewed 5 years later. Families with prior history of shelter use were excluded from the follow-up study. RESULTS Demographic characteristics and housing conditions were the most important risk factors for shelter entry; enduring poverty and disruptive social experiences also contributed. Five years later, four fifths of sheltered families had their own apartment. Receipt of subsidized housing was the primary predictor of housing stability among formerly homeless families (odds ratio [OR] = 20.6, 95% confidence interval [CI] = 9.9, 42.9). CONCLUSIONS Housing subsidies are critical to ending homelessness among families.

Social relationships and vulnerability to becoming homeless among poor families.

This study compares social relationships of 677 mothers in families requesting shelter with those of 495 mothers in housed families, randomly selected from the public assistance caseload in New York City. As hypothesized, women seeking shelter had experienced higher levels of a variety of childhood and adult events indicative of disruptions in social relationships. Contrary to our hypothesis, they were more likely than were housed mothers to have had recent contact with parents, other relatives, and friends, although they felt less able to draw on these resources for help with their current housing needs. More than three fourths of families seeking shelter had already stayed with members of their social network in the past year. The data suggest that they had used up potential sources of support before turning to public shelter.

Mother-child separations among homeless and housed families receiving public assistance in New York city.

We examined the incidence, characteristics, and predictors of separations of children from mothers in 543 poor families receiving public assistance, 251 of whom had experienced homelessness during the previous 5 years. Forty-four percent of the homeless mothers and 8% of housed mothers were separated from one or more children. A total of 249 children were separated from 110 homeless families and 34 children from 23 housed families. Children were placed with relatives and in foster care but were rarely returned to their mothers. Maternal drug dependence, domestic violence, and institutionalization predicted separations, but homelessness was the most important predictor, equivalent in size to 1.9 other risk factors. We infer that policies regarding child welfare and substance abuse treatment should be changed to reduce unnecessary placements. Studies of homeless children who remain with families may be biased if separated children are excluded.

Predictors of Shelter Use among Low-Income Families: Psychiatric History, Substance Abuse, and Victimization.

For poor housed and homeless families in New York City, NY, we examined the degree to which psychiatric and substance-abuse problems and victimization placed the families at elevated risk of requiring emergency housing, and we documented the prevalence of such problems. These problems were infrequently reported by both groups. However, past mental hospitalization, treatment in a detoxification center, childhood sexual abuse, and adult physical abuse were associated with increased risk of homelessness.

Long-Term Associations of Homelessness With Children's Well-Being

To analyze long-term consequences of homelessness, the authors compared 388 formerly homeless children 55 months after shelter entry with 382 housed peers, birth to 17, using mother- and child-reported health, mental health, community involvement, cognitive performance, and educational records. Both groups scored below cognitive and achievement norms. Small group differences favored housed 4- to 6-year-olds on cognition and 4- to 10-year-olds on mental health only. Child care and recent stressful events, which were high, were as or more important than prior homelessness. Only children living with mothers were included, potentially biasing results. Policy implications are discussed.

The Relationship of Residential Instability to Medical Care Utilization Among Poor Mothers in New York City

OBJECTIVES This study examines the relationship between residential instability, including mobility and previous homelessness, and the use of medical care among previously sheltered and never-sheltered mothers in New York City. The study represents one of the first efforts to follow up on families after they are no longer homeless. METHODS Mothers from 543 welfare families in New York City were interviewed, once in 1988 (Time 1) and again beginning in 1992 (Time 2). The sample included 251 families who first entered shelters after their 1988 interview, and 292 families who spent no time in shelters before or after that point. Mothers were asked about the source and volume of medical care used in the year before follow-up. RESULTS Bivariate and multivariate analyses showed that previously sheltered mothers had a greater reliance on emergency departments (EDs) and weaker ties to private physicians or health maintenance organizations (HMOs) than did mothers who never used shelters. Mobility before the Time 1 interview was associated with greater reliance on EDs and absence of a usual source of care. More recent mobility was not associated with a usual source of care. Current residential stability reduced the likelihood of using an emergency department or having no regular source of care. None of the measures of residential instability were related to the volume of outpatient care used by mothers. CONCLUSIONS A history of residential instability, particularly previous shelter use, strongly predicts where poor mothers currently seek health care. Further research is needed to determine whether these patterns of health care use existed before mothers entered shelters. The study provides evidence that upon leaving shelters, mothers are not being well integrated into primary care services.

Calorie Labeling, Fast Food Purchasing and Restaurant Visits

Obesity is a pressing public health problem without proven population‐wide solutions. Researchers sought to determine whether a city‐mandated policy requiring calorie labeling at fast food restaurants was associated with consumer awareness of labels, calories purchased and fast food restaurant visits.

Pregnancy and childbirth: risk factors for homelessness?

A comparison of 704 homeless public assistance families in New York City with 524 families on public assistance who had housing found that pregnancy and recent births were highly correlated with becoming homeless. Thirty-five percent of homeless women were pregnant at the time of the interview, and 26 percent had given birth in the past year, compared with six percent and 11 percent, respectively, of women in the housed sample. In addition, having a baby before age 18 (as had 37 percent of the homeless women and 24 percent of the housed women) was significantly related to homelessness but family size was not.

Integrating a Comparison Group Design into a Theory of Change Evaluation: The Case of the Urban Health Initiative

Abstract This paper describes how we strengthened the theory of change approach to evaluating a complex social initiative by integrating it with a quasi-experimental, comparison group design. We also demonstrate the plausibility of selecting a credible comparison group through the use of cluster analysis, and describe our work in validating that analysis with additional measures. The integrated evaluation design relies on two points of comparison: (1) program theory to program experience; and (2) program cities to comparison cities. We describe how we are using this integrated design to evaluate the Robert Wood Johnson Foundation’s Urban Health Initiative, an effort that aims to improve health and safety outcomes for children and youth in five distressed urban areas through a process of citywide, multi-sector planning and changed public and private systems. We also discuss how the use of two research frameworks and multiple methods can enrich our ability to test underlying assumptions and evaluate overall program effects. Using this integrated approach has provided evidence that the earliest phases of this initiative are unfolding as the theory would predict, and that the comparison cities are not undergoing a similar experience to those in UHI. Despite many remaining limitations, this integrated evaluation can provide greater confidence in assessing whether future changes in health and safety outcomes may have resulted from the Urban Health Initiative (UHI).

Tracing the path out of homelessness: The housing patterns of families after exiting shelter

Housing patterns of homeless families after shelter exit were explored in order to study the role of subsidized housing in the achievement of residential stability. Families (n = 233), interviewed prior to their first entry into emergency shelter, were reinterviewed five years later. At follow-up, 80% were in their own apartments and only 3% were still in shelter. Of 114 families who obtained subsidized housing after their first shelter exit, 83 were still there an average of 3.3 years later. Nearly half (51) of the 119 families who left shelter without a subsidized apartment returned to shelter, but a majority obtained subsidized apartments and achieved stability after a subsequent shelter stay.