4.9 Debra Rog


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4.9 Debra Rog

  1. 1. Exiting Shelter: An Epidemiological Analysis of Barriers and Facilitators for Families Debra J. Rog, PhD Westat Annual Meeting of the National Alliance to End Homelessness July 14, 2011 This research was possible with funding from University of Massachusetts Medical School’s Commonwealth Medicine Division.
  2. 2. Background <ul><li>Families entering shelter often have varying patterns of homelessness and service needs </li></ul><ul><li>Understanding variation in homeless families’ needs not only at entry but at exit from homelessness can inform us how to better match services and inform resource allocation </li></ul>
  3. 3. Key Research Questions: <ul><li>What is the relationship of individual, family, and system level factors to when and how families exit shelter? </li></ul><ul><ul><li>What factors distinguish families who leave early from those who are “stuck” for longer periods? </li></ul></ul><ul><ul><li>What role does conflict and violence play in the exiting process? </li></ul></ul><ul><ul><li>What role does participation in services play in the exiting process? </li></ul></ul>
  4. 4. Presentation Overview <ul><ul><li>Brief overview of methods </li></ul></ul><ul><ul><li>Brief description of families’ background, needs, and service use </li></ul></ul><ul><ul><li>Findings </li></ul></ul><ul><ul><li>Implications of the findings </li></ul></ul>
  6. 6. Data Collection <ul><li>“ Exit” families left shelter within 6 months and were interviewed close to exit time </li></ul><ul><li>“ Stuck” families were in shelter at 6 months and interviewed close to that point; they were also i nterviewed at their exit or at a 4 month follow-up period </li></ul>
  7. 7. Sample Description <ul><li>Overall study sample includes all families either exiting or “stuck” in 6 Worcester family shelters in a 12 month period (11/06-11/07) </li></ul><ul><ul><li>86% of eligible families were interviewed </li></ul></ul><ul><li>For this paper, only families who exited and completed an exit interview were included </li></ul><ul><ul><li>26 ‘stuck’ families were excluded from this analysis because they did not exit during the study period and complete an exit interview </li></ul></ul><ul><li>138 families comprise the sample </li></ul>
  8. 8. Data Collection- Interview Protocol <ul><li>Data collection </li></ul><ul><ul><li>Standardized in-person interviews at point of exit </li></ul></ul><ul><ul><li>Interview domains: </li></ul></ul><ul><ul><ul><li>Demographics and family composition </li></ul></ul></ul><ul><ul><ul><li>Residential history and status </li></ul></ul></ul><ul><ul><ul><li>Education and employment (parent) </li></ul></ul></ul><ul><ul><ul><li>Income and debt </li></ul></ul></ul><ul><ul><ul><li>Criminal and legal involvement (parent) </li></ul></ul></ul><ul><ul><ul><li>Physical and behavioral health (parent) </li></ul></ul></ul><ul><ul><ul><li>Trauma exposure and symptoms (parent) </li></ul></ul></ul><ul><ul><ul><li>Service awareness and receipt (parent) </li></ul></ul></ul><ul><ul><ul><li>Exit process and location </li></ul></ul></ul>
  9. 9. Study Limitations <ul><li>Data were collected at exit; recall issues may influence background and history variables </li></ul><ul><li>Some study measures collected at exit may be less predictive of shelter stay than measures taken at entry; others, however, may be more accurate due to less vulnerability </li></ul><ul><li>Sample is relatively small, though represents a census in one community </li></ul>
  11. 11. Profile of Head of Household (n = 138) Average Age 30 yrs Married 13% Race/Ethnicity: White 33% African-American 23% Hispanic 42% Other 8% HS/GED or > 70% Employed prior to shelter entry 17% Prior Homelessness 58%
  12. 12. Family Composition (n = 138) Average # of Children ≤ 17 2.1 Families with ≥ 1 Other Adult 29% Currently Pregnant 7% Families with 1 or more children away 34%
  13. 13. Housing History (n = 138) Last Place Stayed Prior to Entering Shelter Doubled Up 54% Parent’s Place 18% Own Place 19% Homeless 6% Other 2% Last place stayed was in Worcester 59% Conflicts made it impossible to stay 49%
  14. 14. Employment Status at Exit (n = 138) Currently working 25% Hourly wages $9.86 per hour Employed full-time 93% Job lined up 7% Looking for work 32% Unable to work 38% Health Problems 32% Mental Disability 30% Other Reason 45% * These categories are not mutually exclusive.
  15. 15. Employment Services (self-reported)
  16. 16. Most Common Sources of Income In 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)
  17. 17. Debt Upon Exit (n =138) % with 1 or more sources of debt upon exit 78% Average total amount owed (standard dev.) $3,953 ($5,072) % decreased debt 30% % increased debt 26% % debt same 44% Debt made it difficult to leave shelter 35%
  18. 18. Debt Services (self-reported)
  19. 19. Service Receipt, by Independent Measures of Need (n = 138) Of those in need: Needed It Received it Unmet Need Services Received in Shelter Mental health services 40%* 56% 44% Substance abuse services 42%** 12% 88% Trauma services *1 or more MH indicators **positive screen for A and/or D *** moderate/severe trauma symptoms 32%*** 48% 52%
  20. 20. Exit Locations *p < .05; ***p < .001 (n = 138) Avg. Time in Shelter Own apartment/house with a subsidy 35% 241 days* Own apartment/house without a subsidy 18% 170 days Doubled up 11% 82 days*** Transitional housing 33% 175 days Other arrangement (e.g., substance abuse treatment/mental health facility ) 4% 154 days Total Sample 208 days
  21. 21. <ul><li>FACTORS THAT PREDICT LENGTH OF STAY </li></ul>
  22. 22. Sample for Regression Analysis <ul><li>We excluded </li></ul><ul><ul><li>Father only families (n=6) </li></ul></ul><ul><ul><li>Families who were prematurely asked to leave by shelter staff (N=11) </li></ul></ul><ul><li>Terminated early families </li></ul><ul><ul><li>The average number of days in shelter was 79. </li></ul></ul><ul><ul><li>The primary reasons listed for termination were failure to follow the shelter’s rules, failure to follow the prescribed service plan, and conflict with other guests. </li></ul></ul>
  23. 23. Regression Model Elements <ul><li>Regression model included: </li></ul><ul><ul><ul><li>Specific shelter family resided in </li></ul></ul></ul><ul><ul><ul><li>Demographic characteristics </li></ul></ul></ul><ul><ul><ul><li>Health and behavioral health </li></ul></ul></ul><ul><ul><ul><li>Barriers (debt, conflicts, criminal history, previous homelessness) </li></ul></ul></ul><ul><ul><ul><li>Assets (past employment, monthly income, </li></ul></ul></ul><ul><li>housing subsidy) </li></ul><ul><ul><ul><li>Services </li></ul></ul></ul>
  24. 24. Findings: Predictors of Length of Shelter Stays <ul><li>Families who stay longer are more likely to: </li></ul><ul><ul><li>Have greater number of children (p<.05) </li></ul></ul><ul><ul><li>Have a housing subsidy (p<.01) </li></ul></ul><ul><ul><li>Have a positive alcohol/drug screen (p<.001) </li></ul></ul><ul><ul><li>Have less housing debt (p<.05) </li></ul></ul><ul><li>Families who leave earlier are more likely to </li></ul><ul><ul><li>Have another adult in the household (p<.05) </li></ul></ul>
  26. 26. Discussion of the Findings <ul><li>Overall, few individual level factors have predictive value </li></ul><ul><li>Needs of families who stay longer in shelter are, on the whole, no different from families who leave earlier </li></ul><ul><li>The two strongest predictors suggest two different forces at work: </li></ul><ul><ul><li>Relationship of shelter stays with subsidy suggests that shelter can be a costly ‘holding pattern’ – families who obtain a subsidy wait an average of 8 months </li></ul></ul><ul><ul><li>Individuals with positive substance abuse screen also have longer stays, suggesting either difficulties in finding housing or being perceived as “not ready” to leave shelter </li></ul></ul>
  27. 27. Discussion of the Findings <ul><li>Family composition also is key </li></ul><ul><ul><li>Greater number of children likely makes it challenging to find affordable housing with the requisite number of bedrooms needed </li></ul></ul><ul><ul><li>Having another adult may act as a protective factor, possibly helping with the overall household income and/or other resources; may also reduce tolerance for staying in the shelter </li></ul></ul><ul><li>The role of housing debt is less easily explained </li></ul>
  28. 28. Implications of the Research <ul><li>Findings support the move of systems to rapid-re-housing and prevention </li></ul><ul><ul><li>Limiting shelter stays, but infusing services in a targeted way during the stays that do occur </li></ul></ul><ul><li>Need for attention to linking families to the services and supports they need in the mainstream system </li></ul><ul><ul><li>Need for more attention to employment and related supports, reducing debt, and health related services </li></ul></ul>
  29. 29. <ul><li>For more information: </li></ul><ul><ul><li>Weinreb, L., Rog, D.J., and Henderson, K.A. (2010). </li></ul></ul><ul><ul><li>Exiting shelter: An epidemiological analysis of </li></ul></ul><ul><ul><li>barriers and facilitators for families. Social Science </li></ul></ul><ul><ul><li>Review , 597-614. </li></ul></ul>