Cheryl Zlotnick

Getting off the streets: Economic resources and residential exits from homelessness

Based on a 15-month prospective study, the following variables demonstrated an association with residential stability in a countywide probability sample of 397 homeless adults: female gender, a history of less than 1-year homelessness, absence of a health problem that limited work ability, entitlement-benefit income, and use of subsidized housing. Multivariate analyses show that two forms of public support—entitlement income and subsidized housing—were the most important variables associated with exits from homelessness into stable housing. Homeless adults with substance use disorders were more likely than other homeless adults to obtain unstable, but not stable housing. Homeless adults with mental disorders were no less likely than other homeless adults to report stable housing. Stable housing is necessary to break the cycle of homelessness, and economic resources such as entitlement income and subsidized housing are associated with stable housing for homeless adults.© 1999 John Wiley & Sons, Inc.

Disaffiliation, Substance Use, and Exiting Homelessness

This study tested whether social affiliation was associated with exits from homelessness for a county-wide probability sample of 397 homeless adults who were followed over a 15-month period culminating in 1992. For the total sample, support from family or friends and service use were related to an increased likelihood of exiting from homelessness. Surprisingly, exits from homelessness were associated with social affiliation (i.e., support from family/friends and services use) only among homeless adults who did not have current substance-use disorders. This relationship did not hold for those with current substance-use disorders. Findings suggest that homeless adults without current substance-use disorders may be better able to engage services and support from family/friends to exit homelessness than homeless adults who have current substance-use disorders. Perhaps service providers who are targeting homeless adults with substance-use disorders and want to help them exit homelessness need to emphasize initiating substance-use treatment before addressing other issues.

Longitudinal perspective: adverse childhood events, substance use, and labor force participation among homeless adults

Objectives: We examined the long‐term effects of adverse childhood events on adulthood substance use, social service utilization, and subsequent labor force participation. Methods: A county‐wide probability sample of 397 homeless adults was interviewed three times in a 15‐month period. By using a path model, literature‐based relationships between adverse childhood events and labor force participation with the mediating effects of adulthood substance use and service use were tested. Results: Adverse childhood events were precursors to adulthood alcohol and drug use. Consistent substance use was negatively associated with long‐term labor force participation and with social service utilization among homeless adults. Adverse events at childhood, however, were positively associated with service use. Conclusions: Adverse childhood events may contribute to negative adulthood consequences, including consistent substance use and reduced labor force participation. Agencies that are involved in halting the abuse or neglect also should participate in more preventive interventions. Job‐related assistance is particularly important to facilitate employment and labor force participation among homeless adults.

Foster care children and family homelessness.

OBJECTIVES This study examined the association between family homelessness and childrens placement in foster care. METHODS The prevalence of homelessness in a random sample of 195 young foster children was examined. RESULTS Almost half of the birth parents of the foster children had experienced homelessness. Those children were more likely than other foster children to have siblings in foster care and to be place with nonrelatives. CONCLUSIONS An extremely high prevalence of family homelessness was found among children in foster care. Policy implications of the association between family homelessness and placement into foster care are discussed.

Mindfulness-based stress reduction training is associated with greater empathy and reduced anxiety for graduate healthcare students.

INTRODUCTION Graduate healthcare students experience significant stressors during professional training. Mindfulness-Based Stress Reduction (MBSR) is a behavioural intervention designed to teach self-regulatory skills for stress reduction and emotion management. This study examines the impact of MBSR training on students from five healthcare graduate programs in a quasi-experimental trial. METHODS A total of 13 students completed the MBSR program and were compared with 15 controls. Both groups answered validated questionnaires measuring anxiety, burnout and empathy at baseline, at conclusion of the course (week 8) and 3 weeks post-course completion (week 11). RESULTS Significant decrease in anxiety at weeks 8 and 11 compared with baseline (P<0.001 and P<0.01, respectively) was observed using the Burns Anxiety Inventory. Significant increase in empathy at week 8 (P<0.0096) was observed using the Jefferson Scale of Physician Empathy. Week 11 demonstrated a decrease in empathy from baseline (not statistically significant) across all subjects. No significant differences in burnout scores at weeks 8 and 11 were observed between those in the intervention and control groups. CONCLUSIONS These results provide supportive evidence of MBSR as a behavioural intervention to reduce anxiety and increase empathy among graduate healthcare students.

What Research Tells Us About the Intersecting Streams of Homelessness and Foster Care

This paper reviews mounting evidence linking foster care and homelessness and considers new approaches for intervention. Although there is no causal evidence that family homelessness leads to foster care or vice versa, the association no longer originates solely from samples of homeless people, but also from samples of people with childhood histories of foster care. Many programs work with families, children or youth based on their current living situations and limits imposed by funders. This results in discontinued services when the living situations change. Given the strong and consistent associations between homelessness and foster care, a better approach is to design programs that work with transient families regardless of their living situation. Parenting is key. Whether the parents are living with their children in homeless circumstances or are formerly homeless parents working to reunify with their children, coordinated, comprehensive, trauma-informed and family focused programs are needed to support parenting and family stability.

Substance use and separation of homeless mothers from their children.

OBJECTIVES This study examined whether homeless mothers with substance use problems were more likely to experience separations from their children and whether recent substance use had an impact on the familys ability to receive public entitlement income consistently over the 15-month study period. METHODS This study used an existing longitudinal data set consisting of a county-wide probability sample of 104 homeless women who had children under 18 years old. RESULTS Only 29.1% of women had all their children with them throughout the 15-month study period. Mothers who had been separated from their children were more likely to have a current substance use disorder and to have been homeless for at least a year compared to other homeless mothers. CONCLUSIONS Because many women with recent substance use had already had lost custody of their children, substance use contributed to loss of child custody among mothers who did not have substance use disorders.

The impact of outpatient drug services on abstinence among pregnant and parenting women

Although there is an increasing number of outpatient drug programs, there remains little consensus on which service components are most effective for pregnant and parenting women seeking treatment. In this investigation, we studied 48 women who remained in treatment for 5 consecutive months to: (1) examine differences between clients who maintained 30 to 90 days of abstinence and those who did not and (2) test the association between services and abstinence. Although we found no demographic differences between abstinent and nonabstinent women, we did find that significantly more abstinent women received family therapy services compared to nonabstinent women as they remained in treatment. Furthermore, we found that clients who were abstinent tended to receive more services overall than those who were not. Providers need to consider their population when deciding on which service components will be included: and family therapy is one service component that should be available to pregnant and parenting women.

Health Care for the Homeless: What We Have Learned in the Past 30 Years and What’s Next

In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system. We reflect on lessons learned from the HCH model and its applicability to the changing landscape of US health care.

Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review

Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children. However, very little is known about which specific interventions achieve the best outcomes for children in these overlapping transitional living situations. To address this gap, we review existing literature to identify the most promising practices for children living in transition. A standardised vocabulary specific to each of three electronic databases (i.e. Medline, PsychINFO and CINAHL) was employed to identify studies that described an intervention specifically targeting foster care or homeless children and families. Separate systematic searches were conducted for homeless and foster children, and only studies published in English between January 1993 and February 2009 were selected. The final sample (n = 43) of articles described interventions that fell into two categories: mental health (n = 17) and case management (n = 26). No article included a sample containing both homeless and foster care children, and most studies on homeless children used case management interventions while most studies on foster care children focused on mental health interventions. Few articles employed rigorous study designs. Although repeatedly studies have demonstrated the overlap between populations of homeless and foster care children, studies focused on one population or the other. Virtually all studies on both homeless and foster children devised interventions to reduce trauma and family instability; yet, no evidence-based practice addresses the overlapping needs and potentially relevant evidence-based practice for these two populations. An important and vital next step is to establish an effective evidence-based intervention that reduces the impact of trauma on both U.S. populations of children living in transition.