Dennis P. Culhane

Public service reductions associated with placement of homeless persons with severe mental illness in supportive housing

Abstract This article assesses the impact of public investment in supportive housing for homeless persons with severe mental disabilities. Data on 4,679 people placed in such housing in New York City between 1989 and 1997 were merged with data on the utilization of public shelters, public and private hospitals, and correctional facilities. A series of matched controls who were homeless but not placed in housing were similarly tracked. Regression results reveal that persons placed in supportive housing experience marked reductions in shelter use, hospitalizations, length of stay per hospitalization, and time incarcerated. Before placement, homeless people with severe mental illness used about

Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data

40,451 per person per year in services (1999 dollars). Placement was associated with a reduction in services use of

Public Shelter Admission Rates in Philadelphia and New York City: The Implications of Turnover for Sheltered Population Counts

16,281 per housing unit per year. Annual unit costs are estimated at

Testing a typology of family homelessness based on patterns of public shelter utilization in four U.S. jurisdictions: Implications for policy and program planning

17,277, for a net cost of

Family Dynamics, Housing, and Recurring Homelessness Among Women in New York City Homeless Shelters:

995 per unit per year over the first two years.

The co-occurrence of AIDS and homelessness: results from the integration of administrative databases for AIDS surveillance and public shelter utilisation in Philadelphia

This study tests a typology of homelessness using administrative data on public shelter use in New York City (1988–1995) and Philadelphia (1991–1995). Cluster analysis is used to produce three groups (transitionally, episodically, and chronically homeless) by number of shelter days and number of shelter episodes. Results show that the transitionally homeless, who constitute approximately 80% of shelter users in both cities, are younger, less likely to have mental health, substance abuse, or medical problems, and to overrepresent Whites relative to the other clusters. The episodically homeless, who constitute 10% of shelter users, are also comparatively young, but are more likely to be non-White, and to have mental health, substance abuse, and medical problems. The chronically homeless, who account for 10% of shelter users, tend to be older, non-White, and to have higher levels of mental health, substance abuse, and medical problems. Differences in health status between the episodically and chronically homeless are smaller, and in some cases the chronically homeless have lower rates (substance abuse in New York; serious mental illness in Philadelphia). Despite their relatively small number, the chronically homeless consume half of the total shelter days. Results suggest that program planning would benefit from application of this typology, possibly targeting the transitionally homeless with preventive and resettlement assistance, the episodically homeless with transitional housing and residential treatment, and the chronically homeless with supported housing and long-term care programs.

Recent Incarceration History Among a Sheltered Homeless Population

Abstract Previous estimates of the size and composition of the U.S. homeless population have been based on cross‐sectional survey methodologies. National enumeration efforts have yielded point‐prevalence estimates ranging from 0.11 to 0.25 percent of the population. This study reports data from shelter databases in Philadelphia and New York City that record identifiers for all persons admitted and so make possible unduplicated counts of users. Unduplicated counts of shelter users yield annual rates for 1992 of about 1 percent for both cities and rates near 3 percent over three years in Philadelphia (1990–92) and over five years (1988–92) in New York City. The annual rates are three times greater than rates documented by point‐prevalence studies. Shelter bed turnover rates are reported, as are average monthly first admission and readmission counts over a two‐year period. Implications for future research and public policy are discussed.

Predictors of Exit and Reentry among Family Shelter Users in New York City

Abstract This study tests a typology of family homelessness based on patterns of public shelter utilization and examines whether family characteristics are associated with those patterns. The results indicate that a substantial majority of homeless families stay in public shelters for relatively brief periods, exit, and do not return. Approximately 20 percent stay for long periods. A small but noteworthy proportion cycles in and out of shelters repeatedly. In general, families with long stays are no more likely than families with short stays to have intensive behavioral health treatment histories, to be disabled, or to be unemployed. Families with repeat stays have the highest rates of intensive behavioral health treatment, placement of children in foster care, disability, and unemployment. The results suggest that policy and program factors, rather than family characteristics, are responsible for long shelter stays. An alternative conceptual framework for providing emergency assistance to homeless families is discussed.

The differential impacts of federally assisted housing programs on nearby property values: A philadelphia case study

This study looks at two sets of women who stayed in New York City homeless shelters in 1992—one set as part of a family and the other set as individuals—and at factors associated with an increased risk of their experiencing repeat shelter stays. Descriptive statistics and event history analysis indicate that regardless of whether the women stay in shelters with their families or by themselves, various family dynamics are associated with particular vulnerability to subsequent shelter stays, especially when the women are part of “young” families, are in households with absent children, or disclose a history of domestic violence. Exits from a shelter stay to ones own housing, on the other hand, has the strongest association with avoiding repeat shelter stays. These results suggest that family dynamics and the availability of affordable housing are two important focuses for efforts to reduce the incidence of homelessness among women.

Patterns and determinants of public shelter utilization among homeless adults in New York City and Philadelphia

STUDY OBJECTIVE Administrative databases from the City of Philadelphia that track public shelter utilisation (n=44 337) and AIDS case reporting (n=7749) were merged to identify rates and risk factors for co-occurring homelessness and AIDS. DESIGN Multiple decrement life tables analyses were conducted, and logistic regression analyses used to identify risk factors associated with AIDS among the homeless, and homelessness among people with AIDS. SETTING City of Philadelphia, Pennsylvania, USA. MAIN RESULTS People admitted to public shelters had a three year rate of subsequent AIDS diagnosis of 1.8 per 100 person years; nine times the rate for the general population of Philadelphia. Logistic regression results show that substance abuse history (OR = 3.14), male gender (OR = 2.05), and a history of serious mental disorder (OR = 1.62) were significantly related to the risk for AIDS diagnosis among shelter users. Among people with AIDS, results show a three year rate of subsequent shelter admission of 6.9 per 100 person years, and a three year rate of prior shelter admission of 9%, three times the three year rate of shelter admission for the general population. Logistic regression results show that intravenous drug user history (OR = 3.14); no private insurance (OR = 2.93); black race (OR = 2.82); pulmonary or extra-pulmonary TB (OR = 1.43); and pneumocystis pneumonia (OR = 0.56) were all related to the risk for shelter admission. CONCLUSIONS Homelessness prevention programmes should target people with HIV risk factors, and HIV prevention programmes should be targeted to homeless persons, as these populations have significant intersection. Reasons and implications for this intersection are discussed.