Exiting Shelter: An Epidemiological AnalysisExiting Shelter: An Epidemiological Analysis of Barriers and Facilitators for Families of Barriers and Facilitators for Families

Debra J. Rog, PhDDebra J. Rog, PhDWestatWestat

Annual Meeting of the National Alliance to End HomelessnessAnnual Meeting of the National Alliance to End Homelessness July 14, 2011 July 14, 2011

This research was possible with funding fromThis research was possible with funding fromUniversity of Massachusetts Medical School’s Commonwealth Medicine Division.University of Massachusetts Medical School’s Commonwealth Medicine Division.

BackgroundBackground

Families entering shelter often have varying Families entering shelter often have varying patterns of homelessness and service needspatterns of homelessness and service needs

Understanding variation in homeless Understanding variation in homeless families’ needs not only at entry but at exit families’ needs not only at entry but at exit from homelessness can inform us how to from homelessness can inform us how to better match services and inform resource better match services and inform resource allocationallocation

Key Research Questions:Key Research Questions:

What is the relationship of individual, family, and system What is the relationship of individual, family, and system level factors to when and how families exit shelter?level factors to when and how families exit shelter? What factors distinguish families who leave early from those What factors distinguish families who leave early from those

who are “stuck” for longer periods?who are “stuck” for longer periods?

What role does conflict and violence play in the exiting What role does conflict and violence play in the exiting process?process?

What role does participation in services play in the exiting What role does participation in services play in the exiting

process? process?

Presentation OverviewPresentation Overview

Brief overview of methodsBrief overview of methods Brief description of families’ background, needs, Brief description of families’ background, needs,

and service useand service use FindingsFindings Implications of the findingsImplications of the findings

STUDY DESIGN AND METHODSSTUDY DESIGN AND METHODS

Data CollectionData Collection

““Exit” families left shelter within 6 months Exit” families left shelter within 6 months and were interviewed close to exit timeand were interviewed close to exit time

““Stuck” families were in shelter at 6 Stuck” families were in shelter at 6 months and interviewed close to that months and interviewed close to that point; they were also ipoint; they were also interviewed at their exit nterviewed at their exit or at a 4 month follow-up periodor at a 4 month follow-up period

Sample DescriptionSample Description

Overall study sample includes all families either exiting Overall study sample includes all families either exiting or “stuck” in 6 Worcester family shelters in a 12 or “stuck” in 6 Worcester family shelters in a 12 month period (11/06-11/07)month period (11/06-11/07)

86% of eligible families were interviewed86% of eligible families were interviewed

For this paper, only families who exited and For this paper, only families who exited and completed an exit interview were includedcompleted an exit interview were included 26 ‘stuck’ families were excluded from this analysis because 26 ‘stuck’ families were excluded from this analysis because

they did not exit during the study period and complete an they did not exit during the study period and complete an exit interviewexit interview

138 families comprise the sample138 families comprise the sample

Data Collection- Interview ProtocolData Collection- Interview Protocol

Data collectionData collection Standardized in-person interviews at point of exitStandardized in-person interviews at point of exit Interview domains:Interview domains:

Demographics and family compositionDemographics and family composition Residential history and statusResidential history and status Education and employment (parent)Education and employment (parent) Income and debtIncome and debt Criminal and legal involvement (parent)Criminal and legal involvement (parent) Physical and behavioral health (parent)Physical and behavioral health (parent) Trauma exposure and symptoms (parent)Trauma exposure and symptoms (parent) Service awareness and receipt (parent)Service awareness and receipt (parent) Exit process and location Exit process and location

Study LimitationsStudy Limitations

Data were collected at exit; recall issues may Data were collected at exit; recall issues may influence background and history variablesinfluence background and history variables

Some study measures collected at exit may be less Some study measures collected at exit may be less predictive of shelter stay than measures taken at predictive of shelter stay than measures taken at entry; others, however, may be more accurate due entry; others, however, may be more accurate due to less vulnerabilityto less vulnerability

Sample is relatively small, though represents a Sample is relatively small, though represents a census in one communitycensus in one community

DESCRIPTIVE FINDINGSDESCRIPTIVE FINDINGS

Profile of Head of HouseholdProfile of Head of Household

(n = 138)(n = 138)

Average AgeAverage Age 30 yrs30 yrs

MarriedMarried 13%13%

Race/Ethnicity:Race/Ethnicity:

WhiteWhite 33%33%

African-AmericanAfrican-American 23%23%

HispanicHispanic 42%42%

OtherOther 8%8%

HS/GED or >HS/GED or > 70%70%

Employed prior to shelter entryEmployed prior to shelter entry 17%17%

Prior HomelessnessPrior Homelessness 58%58%

Family CompositionFamily Composition

(n = 138)(n = 138)

Average # of Children ≤ 17Average # of Children ≤ 17 2.1 2.1

Families with ≥ 1 Other AdultFamilies with ≥ 1 Other Adult 29%29%

Currently PregnantCurrently Pregnant 7%7%

Families with 1 or more children awayFamilies with 1 or more children away 34%34%

Housing HistoryHousing History(n = 138)(n = 138)

Last Place Stayed Prior to Entering ShelterLast Place Stayed Prior to Entering Shelter

Doubled UpDoubled Up 54%54%

Parent’s PlaceParent’s Place 18%18%

Own PlaceOwn Place 19%19%

HomelessHomeless 6%6%

OtherOther 2%2%

Last place stayed was in WorcesterLast place stayed was in Worcester 59%59%

Conflicts made it impossible to stayConflicts made it impossible to stay 49%49%

Employment Status at ExitEmployment Status at Exit(n = 138)(n = 138)

Currently workingCurrently working 25%25%Hourly wagesHourly wages $9.86 per hour$9.86 per hour

Employed full-timeEmployed full-time 93%93%

Job lined upJob lined up 7%7%

Looking for workLooking for work 32%32%

Unable to workUnable to work 38%38%Health ProblemsHealth Problems 32%32%Mental DisabilityMental Disability 30%30%Other ReasonOther Reason 45%45%

* These categories are not mutually exclusive.* These categories are not mutually exclusive.

Employment ServicesEmployment Services(self-reported)(self-reported)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

50%

Job locationassistance

Job preparationprograms

Job training Transportationto and from job

Childcareassistance

Education/GEDprogram

Received It Unmet need

Most Common Sources of IncomeMost Common Sources of IncomeIn past 30 days: (n = 138)

TANF/GA (state/county) 67%

Employment 25%

Child support 13%

Family/spouse contribution 13%

SSDI/SSI 16%

SSDI/SSI – Child 8%

Average Total Income $ 750 ($559)

Debt Upon ExitDebt Upon Exit(n =138)(n =138)

% with 1 or more sources of debt upon exit% with 1 or more sources of debt upon exit 78%78%

Average total amount owed Average total amount owed (standard dev.)(standard dev.)

$3,953$3,953($5,072)($5,072)

% decreased debt% decreased debt 30%30%

% increased debt% increased debt 26%26%

% debt same% debt same 44%44%

Debt made it difficult to leave shelterDebt made it difficult to leave shelter 35%35%

Debt ServicesDebt Services(self-reported)(self-reported)

0%5%

10%15%20%25%30%35%40%45%50%

Funds to pay backutilities

Moneymanagement

classes

Help learning tosave

Help negotiatingpayment plan

Received It Unmet need

Service Receipt, by Independent Service Receipt, by Independent Measures of NeedMeasures of Need

(n = 138)(n = 138) Of those in need:Of those in need:

Needed Needed ItIt

Received Received itit

Unmet Unmet NeedNeed

Services Received in ShelterServices Received in Shelter

Mental health servicesMental health services 40%*40%* 56%56% 44%44%

Substance abuse servicesSubstance abuse services 42%**42%** 12%12% 88%88%

Trauma servicesTrauma services

*1 or more MH indicators*1 or more MH indicators

**positive screen for A and/or D**positive screen for A and/or D

*** moderate/severe trauma symptoms*** moderate/severe trauma symptoms

32%***32%*** 48%48% 52%52%

Exit LocationsExit Locations(n = (n = 138)138)

Avg. Time in Avg. Time in ShelterShelter

Own apartment/house with a subsidyOwn apartment/house with a subsidy 35%35% 241 days*241 days*

Own apartment/house without a subsidyOwn apartment/house without a subsidy 18%18% 170 days170 days

Doubled upDoubled up 11%11% 82 days***82 days***

Transitional housingTransitional housing 33%33% 175 days175 days

Other arrangement Other arrangement (e.g., substance abuse treatment/mental health facility(e.g., substance abuse treatment/mental health facility))

4%4% 154 days154 days

Total SampleTotal Sample 208 days208 days

*p < .05; ***p < .001

FACTORS THAT PREDICT FACTORS THAT PREDICT LENGTH OF STAYLENGTH OF STAY

Sample for Regression AnalysisSample for Regression Analysis

We excludedWe excluded Father only families (n=6)Father only families (n=6) Families who were prematurely asked to leave by shelter Families who were prematurely asked to leave by shelter

staff (N=11)staff (N=11)

Terminated early familiesTerminated early families The average number of days in shelter was 79.The average number of days in shelter was 79. The primary reasons listed for termination were failure to The primary reasons listed for termination were failure to

follow the shelter’s rules, failure to follow the prescribed follow the shelter’s rules, failure to follow the prescribed service plan, and conflict with other guests. service plan, and conflict with other guests.

Regression Model ElementsRegression Model Elements

Regression model included:Regression model included:o Specific shelter family resided inSpecific shelter family resided ino Demographic characteristicsDemographic characteristicso Health and behavioral healthHealth and behavioral healtho Barriers (debt, conflicts, criminal history,Barriers (debt, conflicts, criminal history,

previous homelessness)previous homelessness)o Assets (past employment, monthly income, Assets (past employment, monthly income,

housing subsidy)housing subsidy)o ServicesServices

Findings: Findings: Predictors of Length of Shelter StaysPredictors of Length of Shelter Stays

o Families who stay longer are more likely to:Families who stay longer are more likely to:o Have greater number of children Have greater number of children (p<.05)(p<.05)

o Have a housing subsidy Have a housing subsidy (p<.01)(p<.01)

o Have a positive alcohol/drug screen Have a positive alcohol/drug screen (p<.001)(p<.001)

o Have less housing debt Have less housing debt (p<.05)(p<.05)

o Families who leave earlier are more likely toFamilies who leave earlier are more likely too Have another adult in the household Have another adult in the household (p<.05)(p<.05)

DISCUSSION AND DISCUSSION AND IMPLICATIONSIMPLICATIONS

Discussion of the FindingsDiscussion of the Findings Overall, few individual level factors have predictive Overall, few individual level factors have predictive

valuevalue Needs of families who stay longer in shelter are, on Needs of families who stay longer in shelter are, on

the whole, no different from families who leave earlierthe whole, no different from families who leave earlier The two strongest predictors suggest two different The two strongest predictors suggest two different

forces at work:forces at work: Relationship of shelter stays with subsidy suggests that Relationship of shelter stays with subsidy suggests that

shelter can be a costly ‘holding pattern’ – families who shelter can be a costly ‘holding pattern’ – families who obtain a subsidy wait an average of 8 months obtain a subsidy wait an average of 8 months

Individuals with positive substance abuse screen also have Individuals with positive substance abuse screen also have longer stays, suggesting either difficulties in finding housing longer stays, suggesting either difficulties in finding housing or being perceived as “not ready” to leave shelteror being perceived as “not ready” to leave shelter

Discussion of the FindingsDiscussion of the Findings Family composition also is keyFamily composition also is key

Greater number of children likely makes it Greater number of children likely makes it challenging to find affordable housing with the challenging to find affordable housing with the requisite number of bedrooms neededrequisite number of bedrooms needed

Having another adult may act as a protective Having another adult may act as a protective factor, possibly helping with the overall factor, possibly helping with the overall household income and/or other resources; may household income and/or other resources; may also reduce tolerance for staying in the shelteralso reduce tolerance for staying in the shelter

The role of housing debt is less easily The role of housing debt is less easily explainedexplained

Implications of the ResearchImplications of the Research

Findings support the move of systems to rapid-Findings support the move of systems to rapid-re-housing and preventionre-housing and prevention Limiting shelter stays, but infusing services in a Limiting shelter stays, but infusing services in a

targeted way during the stays that do occurtargeted way during the stays that do occur

Need for attention to linking families to the Need for attention to linking families to the services and supports they need in the services and supports they need in the mainstream systemmainstream system Need for more attention to employment and Need for more attention to employment and

related supports, reducing debt, and health related related supports, reducing debt, and health related servicesservices

For more information:For more information:

Weinreb, L., Rog, D.J., and Henderson, K.A. (2010).Weinreb, L., Rog, D.J., and Henderson, K.A. (2010).

Exiting shelter: An epidemiological analysis ofExiting shelter: An epidemiological analysis of

barriers and facilitators for families. barriers and facilitators for families. Social ScienceSocial Science

ReviewReview, 597-614., 597-614.