Tim Aubry, Ph.D., C.Psych. Centre for Research on Educational and Community Services

1. Identifying Factors that Facilitate Becoming Re-Housed and Improving Personal Well-Being for Persons who are Homeless Tim Aubry, Ph.D., C.Psych. Centre for Research on Educational and Community Services University of Ottawa Presentation at the Institute of Population Health April 15, 2008

2. Etiology of Homelessness • Homelessness = Poverty X Vulnerability* (* Vulnerabilities – e.g., social isolation, developmental transitions, family conflict, relationship dissolution, domestic violence, mental illness, addictions)

3. Research Objectives • Objectives of the study were: (i) to identify factors that facilitate or impede a person’s exit from homelessness, and (ii) examine the relationship between becoming re-housed and health • One of only a small number longitudinal studies on homelessness conducted in Canada

4. Research Questions • 1. What is the housing trajectory of participants over the course of the study? • 2. What are the resources and risk factors associated with exiting homelessness? • 3. Are there improvements in physical health functioning and mental health functioning associated with the exiting of homelessness?

5. Previous Research: Exits from Homelessness • Predictors of a successful exit from homelessness include: • Personal characteristics(Wong et al., 1998; Caton et al., 2005) : • Demographics: Younger age, being female • Having children • Orwin et al. (2005) found that having others dependent on one for food an shelter was a protective factor for becoming housed and preventing homelessness • Good coping skills (Caton et al., 2005) • Shorter history of homelessness (Pilianvin et al., 1996; Zlotnick et al., 1999)

6. Previous Research: Exits from Homelessness • Interpersonal Resources: • Social support (Cohen et al., 1997; Caton et al., 2005) • Caton et al. found that family support, in particular, predicted shorter episodes of homelessness • Community resources:(e.g. Wong & Piliavin, 1997; Stojanovic et al., 1999; Shinn et al., 1998; Zlotnick et al., 1999; Piliavin et al., 1996; Caton et al., 2005) • Use of community services(Cohen et al., 1997) • Employment & job training • Earned income • Social benefits • Subsidized housing

7. Model of Risk Factors and Resources Related to Exiting Homelessness Improved Health Risk Factors Physical health problems Mental health problems Substance abuse problems - • Resources • Individual • Employment History • Educational Attainment • Housing Stability • Sense of Empowerment • Interpersonal • Size of social network • Availability of social support • Satisfaction with social support • Community • Income support • Use of health services • Use of social services • Subsidized housing + Exit from Homelessness +

8. Method • Two in-person interviews that were approximately 24 months apart • Located participants through friends, family members, and service providers • Used empirically validated measures when available: HIST (Toro et al., 1995); SSQ (Saranson et al., 1983); ISEL (Cohen & Hoberman, 1983); CAGE (Chan et al., 1994); DAST (Skinner, 1982); SF-36 (Ware et al., 1998);

9. Method • 412 individuals interviewed in the first phase (87 single men, 85 single women, 79 male youth, 78 female youth, and 83 adults in families) • 255 participants (62%) re-interviewed in the second phase (43 single men, 55 single women, 49 male youth, 50 female youth, and 58 adults in families) • Those re-interviewed did not differ from drop-outs in demographics or housing characteristics, although they had typically resided in Ottawa for a longer time

10. Results: Housing Trajectories • Three-quarters (76%) of respondents had been housed for 90 days or more at the time of being re-interviewed • Most common type of housing in which they lived was apartments (52%), followed by townhouses (17%) and houses (14%) • 79% of those who were housed rated the overall quality of their housing as being “somewhat good”, “good”, or “very good” • Families most likely to be housed (97%); single men least likely to be housed (49%) • Majority of families (78%) and over one-half of single women (51%) living in subsidized housing; no single men living in subsidized housing

11. Results: Housing Trajectories

12. Results: Resources and Risk Factors Predictive of Housing Status at Follow-up • “Stably housed” = housed for 90(+) days • Demographic characteristics: • younger, female, being in a family • Individual resources • higher number of moves • higher level of personal empowerment • Community resources: • accessing subsidized housing • higher level of income • No risk factors or interpersonal factors significantly related to housing status at follow-up

13. Risk Factors Physical Health Mental Health Drug Use Alcohol Use

14. Individual Resources Housing Stability** + Educational Attainment Work History + Personal Empowerment* Chi2 (5) = 12.19, p < .05; R2 ch = 6% **p < .05; p < .10

15. Community Resources Income** + Health Services Social Services + Subsidized Housing* Chi2 (4) = 19.11, p = .001, R2 ch = 9% *p < .01; **p = .001

16. Qualitative Findings: How People Explain Their Housing Experiences • Economic Factors: • Many respondents identified the gap between what they could afford and the cost of rent as the major source of their housing problem. • This was particularly acute among individuals receiving social assistance and those working low-wage jobs. More social housing would help the problem: “Even on welfare, after rent you're left with less than $100.”

17. Qualitative Findings: How People Explain Their Housing Experiences • Housing arrangements: • In order to afford housing, people sometimes shared costs by living with roommates or romantic partners, or by returning to the family home. • In some cases, this resulted in interpersonal conflicts that resulted in new episodes of homelessness.

18. Qualitative Findings: How People Explain Their Housing Experiences • Substance use problems: • Some respondents identified personal drug use problems, or the easy availability of drugs and open drug use in their living environments, as obstacles to staying housed. “In my apartment building there are lots of drugs around. People always have drugs in the building and the dealers are always harassing you. [If] you are trying to move on from being an addict, they [drug dealers and other drug users] don’t understand and put you down for not using drugs.”

19. Qualitative Findings: How People Explain Their Housing Experiences • Violence and abuse: • Family conflicts – which included running away, being forced out of the home by parents and experiencing abuse at home – were described as obstacles to stable housing by many youth. • Some adult women identified violence or abuse by a partner as contributing to their homelessness. “I am homeless because my husband abused me and I needed to leave with my children. Here, where we are now, it’s very well organized. They’ve really helped us – morally, mentally, in every way.”

20. Qualitative Findings: How People Explain Their Housing Experiences • Health status: • Physical or mental health problems impacted the ability of some respondents to accessing stable housing. • In some cases, the impairment was the route to stable housing, and in other circumstances it was the reason for their housing difficulties.

21. Qualitative Findings: How People Explain Their Housing Experiences • Housing and neighbourhood characteristics: • Some women, particularly those with children, emphasized the value of living in a safe neighbourhood. • For others, negative environmental features, such as fear, neighbours with dangerous lifestyles and restricted access to amenities such as parks and recreation centres were reasons for leaving their housing.

22. Results: Changes in Health Functioning Associated with Changes in Housing Status • Housing status at follow-up was not related to changes in either physical or mental health from phase 1 to phase 2 • HOWEVER, participants were also asked about their perception of the quality of their housing • Better perceived housing quality at follow-up was significantly related to improvements in mental health functioning from phase 1 to phase 2

23. Does Becoming Housed Lead to Improvements in Health? Leaving Homelessness Mental Health + Housing Quality* *F ch (1, 250) = 5.25, p < .05, R2 = 2%

24. Results: Changes in Health Functioning Associated with Changes in Housing Status

25. Conclusions / Implications • Affordable housing and income emerge as the key community resources behind exiting from homelessness. Policies and programs directed at housing, income support, and employment are recommended.

26. Conclusions / Implications • Becoming housed after a period of homelessness did not produce, at least in the short-term, improvements in health. Housing quality emerges as an important contributor to mental health. Policies ensuring that the quality of affordable housing meets an acceptable standard are recommended.

27. Future Research • Three city two-year longitudinal study funded by CIHR (Ottawa, Toronto, Vancouver) and conducted by REACH3 • Cohort of single adults (N = 600) starting out homeless and another cohort (N = 600) of single adults who are precariously housed • Study pathways in and out of homeless with three interviews over two year period • Examine the interaction between housing status and health

28. Study Findings: Further Information • http://www.socialsciences.uottawa.ca/crcs/eng/pub_proj_reports.asp