Jim Baumohl

The Prevention of Homelessness Revisited

Conceptual and methodological problems plague efforts to prevent homelessness. Attempts to identify individuals at risk are inefficient, targeting many people who will not become homeless for each person who will. Such interventions may do useful things for needy people, but evidence that they prevent homelessness is scant. Subsidized housing, with or without supportive services, has ended homelessness for families and played a key role in ending it for people with serious mental illnesses. Other risk factors may be less important once housing is secured. But programs that allocate scarce housing may simply reallocate homelessness, determining who goes to the head of the line for housing, not shortening the line itself. We recommend reorienting homelessness prevention from work with identified at-risk persons to efforts to increase the supply of affordable housing and sustainable sources of livelihood nationwide or in targeted communities.

Falling Through the Cracks: Mental Disorder and Social Margin in a Young Vagrant Population

Twenty-two percent of a young vagrant population reported on in this study, and believed to be representative of similar groups in many American cities, have been hospitalized for psychological disorder. These young mentally disordered vagrants are the most marginal members of the vagrant subculture, lacking social margin (i.e. resources, relationships, and a credible identity) with their families, community services and their peers. Their critical lack of social margin is due to an incongruence of expectations between disordered vagrants and potential benefactors. This incongruence generates a situation in which apparently eligible clients fall or slip through cracks in the service system. Ultimately, these individuals will become the core of a new chronically disordered and dependent population housed, at best, in community-based sheltered living arrangements as they grow older.

Drink, Drugs and Disability: An Introduction to the Controversy

This paper reviews the history of the drug addiction and alcoholism (DA&A) program within Supplemental Security Income (SSI) and the controversies that dogged the years before its termination in 1996. The DA&A program began in 1972, and for reasons understood early on, it was susceptible to rapid growth and discrediting scandal. Through the mid-1980s, the program remained very small, mainly because of a conservative judicial climate that limited the grounds for claiming substance abuse as a disabling impairment. Once the legal barriers were breached, SSI became an attractive welfare alternative for impoverished substance abusers and for local governments seeking to shift welfare and medical assistance costs to the federal government. By the early 1990s, program growth was extraordinary, and oversight bodies deemed the program “out of control.” This was compounded by highly publicized misuse of funds by beneficiaries. Seen as an instance of state-induced harm, the program became an early target of the conservative welfare reformers who took control of Congress after the 1994 elections.

The Methodology of the Multi-site Study of the Termination of Supplemental Security Income Benefits for Drug Addicts and Alcoholics

This paper describes the quantitative and qualitative methodologies used in a nine-site, two-year study of the effects of terminating Supplemental Security Income (SSI) for drug addiction and alcoholism (DA&A). The quantitative component of the study involved a longitudinal survey that collected data on 1,744 former DA&A recipients, representing about one-fourth of the national population, and achieved an aggregate follow-up rate of 82%. Despite limitations in questionnaire design and implementation, the survey provided reasonably valid data in the following areas: demographics, employment/income, medical/psychiatric status, drug and alcohol use, legal involvement, family/social functioning, food and hunger, housing, and victimization. The qualitative component examined the lives of a subsample to help clarify important issues that could not be addressed within the more structured protocol and format of the longitudinal survey. The paper also presents details on the survey instrument design, the results of validation studies of selected survey items, and data collection protocols across study sites.

The Bottom Line: Employment and Barriers to Work among Former SSI DA&A Beneficiaries

The Supplemental Security Income (SSI) program for drug addicts and alcoholics (DA&A beneficiaries) ended in January 1997 without any special effort to create employment for those who lost benefits. Relying on data from a nine-site, two-year panel study of 1,764 former DA&A recipients and detailed semi structured interviews with subsamples in four sites, this paper examines employment outcomes and barriers to employment among 611 respondents who lost SSI and did not replace it with another form of publicly funded income assistance. Despite the tight labor market of the late 1990s, this group was plagued by widespread unemployment and sub-employment. At the two-year follow-up, only 25% earned

Substance Abuse and Welfare Policy at the New Century

500 per month or more, and only 12% typically earned this much throughout the study. Given their age, health problems and limited human capital, it is likely that many former DA&A beneficiaries will remain indigent, returning to the SSI rolls when they requalify upon turning 65.

Inebriety, Doctors, and the State

Drawing on findings from the SSI Study and other research, this paper takes up various policy questions fundamental to any welfare program for substance abusers. The paper considers the place of disability benefits in the U.S. system of categorical aid and the problems raised by substance abuse for the disability category. It discusses the desirable objectives of a welfare program for substance abusers and the various mechanisms by which they might be achieved. And finally, it considers how any new program might be positioned in the context of categorical aid and American federalism.

Now Invited to Testify: Former Beneficiaries Appraise the SSI Drug Addiction and Alcoholism Program

This chapter recounts what is known about the international development of treatment institutions for inebriates in the century before 1940. It begins with the origins of treatment in the self-help temperance movement of the 1830s and 1840s and the founding of the first inebriate homes, tracing in the United States the transformation of these small, private, spiritually inclined programs into the medically dominated, quasipublic inebriate asylums of the late 19th century. A similar institutional development occurred in other English-speaking countries. Both in the United States and Britain, these institutions almost disappeared by the end of the First World War. In Germany and Switzerland, a three-tier system of community advice bureaus, inpatient sanatoria, and work camps developed at the turn of the century; an analogous system, with temperance boards at the community level, developed in Nordic countries between 1912 and 1940. The societal emphasis on the problem of impoverished inebriates often turned inebriate treatment efforts in the direction of coercive and custodial handling.

Termination of Supplemental Security Income Benefits for Drug Addiction and Alcoholism: Results of a Longitudinal Study of the Effects on Former Beneficiaries

As part of the larger SSI Study, we conducted detailed semistructured interviews with 156 respondents in four sites. They spoke at length about matters of legislative concern during the reform and subsequent abolition of the drug addiction and alcoholism (DA&A) program. Respondents were quite aware of the problems considered by Congress. Some acknowledged using SSI payments to buy alcohol and other drugs, and a few claimed to have squandered large retroactive payments. Most insisted that they spent their checks wisely, however, and discussed how they did so. With a remarkable degree of consensus, respondents favored the DA&A programs paternalistic features of representative payment and mandatory treatment, and while less in agreement about time limits, they approved in theory of benchmarks to measure progress. A substantial majority believed the DA&A program had been an unalloyed good, and only 12 judged it to have been wholly harmful.

Building systems to manage inebriates: the divergent paths of California and Massachusetts, 1891–1920

This article reviews the results of a multisite cohort study on effects of terminating Supplemental Security Income benefits for drug addiction and alcoholism. Within 2 years of the program’s termination, 35–43 percent of participants requalified for disability benefits for another impairment. Regardless of requalification status, substance abuse treatment participation declined sharply and illegal drug use was prevalent. Although many of those who did not requalify lost income, medical benefits, and housing, these losses lessened over time and were not associated with increased psychological or medical problems or with declines in other aspects of participants’ lives.