Homeless People and the Barriers They Face

Introduction

 The United States Department of Housing (HUD, 2012) reported the cost to keep one homeless person on the street was $40,000 a year. Homeless people suffer a disproportionate amount of illness and injury with greater severity compared to the general population (Song, J., Ratner, E., Bartels, D., Alderton, L., Hudson, B., Ahluwalia, J., 2007).  Homeless persons have the highest mortality rates in developed nations, regardless of age or sex and they die at rates from three to ten times the general population (Song et al., 2007). They also suffer from premature mortality, with an average age of death in Atlanta, San Francisco, and Seattle of 44, 41, and 47, compared to the national average of 76.5. With populations rising, the homeless population is growing in numbers and in age (Cooper, 2015).

With the homeless population increasing in age, researchers must identify which issues account for this systemic problem. This research will focus on three of those issues. One topic is mental illness that people living on the streets have. The second issue is substance abuse (McNeil, Guirguis-Younger, Dilley, Aubry, Turnbull, and Hwang, 2012). The third issue is the structural barriers within the welfare system making it almost impossible for homeless people to get help (Cooper, 2015).

The goal of this study is to uncover obstacles older homeless people face, impeding successful transition to life off the streets. A major gap in the literature is lack of research on older homeless persons (age 65 and older).

Literature Review

 Chronic homelessness is defined as an occurrence of homelessness lasting more than one year, or four episodes of homelessness in the previous two years in an individual who has an incapacitating condition (Cooper, 2015). Chronic homelessness is the most serious type of homelessness. Many chronically homeless have a mental illness. On any given day or night, there are thousands of homeless men and women living on the streets in the U.S. (Petersen, 2013). This has become a major health concern for these individuals and society. Many of these men and women have disabling conditions affecting their ability to find help (CDC, 2018; Dickson-Gomez, McAuliffe, Convey, Weeks, and Owczarzak, 2011).

Mental Illness

Many of the homeless population living on skid row in Los Angeles carry a mental health diagnosis (CDC, 2018). Domestic violence is also reality for many homeless women and children. Many flee from abusive partners or broken families and decide it is safer to live on the streets than at home (Forlan, 2016). Others have been abused or kicked out by their families because their mental illness is too disruptive (De Venanzi, 2008).

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Being homeless with a mental illness and no family can be overwhelming. According to researchers, Carton, Young, and Kelly (2010) it is paramount that homeless men and women living on the streets have a social network, if they are going to be successful in obtaining long term help. This social network can be a viable substitute for family (Carton et al., 2010). A study was conducted using Assertive Community Treatment (ACT) services in aiding homeless people obtain housing and jobs. The results found that team members in ACT, served as a practical social support network (Carton, 2010).

Substance Abuse

Homeless people who are suffering from addiction do not qualify for most services because they are addicted to illicit drugs (Dickson-Gomez, 2011). For example, half way houses do not accept people who are using drugs or alcohol (McNeil, et al, 2012). Furthermore, many of these people are growing older and becoming very sick (Song, Ratner, Bartels, Alderton, Hudson, and Ahluwalia, 2007). Research suggests there are organizations like ACT, who assist dying homeless people with addiction issues, receive end-of-life care (Carton et al., 2010). A major limitation in previous literature is the lack of research on the aging population of homeless. In addition, men are far more likely to be studied in previous research than are women. Women account for 70% of those living in poverty yet they are underrepresented in studies (Forlan, 2016).

Structural Barriers

De Venanzi (2008) claims that welfare agencies may be contributing to chronic homelessness instead of helping. Cooper (2015), examines institutional barriers to receiving help and support. Amster (2003) states the lack of communication and respect of homeless people’s time is rendered a major issue in treating chronic homelessness. Wasted time is filled with waiting for an appointment, traveling time, and time standing in line. There is no time left in the day to look for a job, secure housing, or formulate other future goals (Cooper, 2015).

In addition, Amster (2003) identifies recent patterns of exclusion where homeless are restricted to areas away from public sight. Communities treat homeless men and women like criminals and want them to be sanctioned away from public view (Cummings, 2011). Spatialization is posing a major problem for homeless because they have literally no place to go. They are being pushed into a space so small that it creates spaces like skid row in Los Angeles (Amster, 2003).

 The goal of this study is to understand the realities older homeless women face while living on the streets. Only then can these problems be addressed and reformed. As a first step to the aforementioned goal, this study will explore the following research question: What are the obstacles older homeless women face preventing them from getting help?

Purpose of the Study

 The purpose of this study is to observe homeless women who reject institutional aid in efforts to get off the streets. There have been several studies that have been conducted to explore the reasons homeless men have been rendered incapable of getting off the streets, but there is a need for studies with an emphasis on homeless women with a small sample size to show in depth reasons women choose to live on the streets rather than accept institutional aid. This study will explore the perspective of the women living in the homeless community regarding their decisions to live on the streets; why getting institutional aid is almost impossible. Studies have similar responses and themes, but lack in depth interviews and observations of women who could allow full expression and opinions of street life that may lead to several discussions revolving around institutional barriers. Understanding the factors and why women in the homeless community choose to live on the streets instead of accepting institutional assistance will help determine what needs to be addressed so that people can get off the streets and into sustainable housing.

Methods

 The goal is to conduct research with open ended questions for participants to see what factors are identified that has not been addressed in previous studies; to expand on factors that have been produced by participants in previous studies. A qualitative approach will be utilized to obtain data through direct observations and semi-structured interviews of homeless women frequenting Sarah’s shelter in Chicago. A translator will be provided for those who are not confident in speaking or reading English. Conversations will be initiated for semi-structured interviews and small focus groups will be formed to discuss topics such as personal values and knowledge of institutional demands. Open-ended questions will address daily routine, self-preservation, access to healthy food and shelter, shelter life vs life on the street and pros and cons of both.

 This study will utilize convenience sampling of members that frequent Sarah’s Circle in Chicago. The target population will be 65 and older homeless women. Twelve participants will be chosen at Sarah’s Circle who frequent the shelter more than four times in one week. There will be three focus groups of four participants that will be randomly assigned. The focus group will meet once for three hours to discuss the questions. The facilitator will initiate open-ended questions, collect demographic information, and collect signed consent forms. These focus groups will meet in an empty room at Sarah’s Circle. Each participant in this study will receive a $50.00 gift certificate to Jewel-Osco that will be given as soon as the study is completed. The primary researcher will submit this proposal and obtain confirmation from the Institutional Review Board before beginning this possible study.

     Data Analysis Plan

 The primary researcher will use audiotape to record focus group discussions and try to locate possible themes throughout the discussions. A translator for any person who does not speak and understand English fluently will be there to translate. A Grounded Theory Approach will be utilized to analyze the data. After analysis of data, the information will be used to implement stronger policy to help homeless women in this area of Chicago.

Social Work and Multicultural Relevance

 Homeless women and men can benefit from this study because it can bring awareness to the struggle people face when living on the street and why they choose not to live in shelters or subsidized housing. Policy makers can then address systematic issues within the welfare agencies directly oppressing homeless women and men by effecting policy changes within the welfare agencies. In addition, the results of this study may influence other researchers to conduct similar studies, thus enhancing systematic advancement helping this population.

References

• Amster, R. (2003). Patterns of exclusion: Sanitizing space, criminalizing homelessness. Social Justice, 30(1 (91)), 195-221. Retrieved from https://www.jstor.org/stable/29768172
• Carton, A.D., Young, M.S., & Kelly, K.M. (2010). Changes in sources and perceived quality of social supports among formerly homeless persons receiving assertive community treatment services. Community Mental Health Journal, 46(2), 156-163. doi: 10.1007/s10597-009-9185-8
• Cooper, A. (2015). Time seizures and the self: Institutional temporalities and self-preservation among homeless women. Culture, Medicine and Psychiatry, 39(1), 162-185. doi: 10.1007/s11013-014-9405-8
• Cummings, M. M. (2011). The continued illegalization of compassion: United States v. Millis and its effects on humanitarian work with the homeless. Boston College Third World Law Journal, 31(2), 439-455. doi:10. 1111/1467-9906.00116/pdf
• De Venanzi, A. (2008). The institutional dynamics of homelessness. International Journal of Sociology and Social Policy, 28(3/4), 129-145. doi: 10.1108/01443330810862197
• Dickson-Gomez, J., McAuliffe, T., Convey, M., Weeks, M., & Owczarzak, J. (2011). Access to housing subsidies, housing status, drug use and HIV risk among low-income U.S. urban residents. Substance Abuse Treatment, Prevention, and Policy, 6(1), 31. doi:10.1108/01443330810862197
• Flagg, K. (2011). Mending the safety net through source of income protections: The nexus between antidiscrimination and social welfare law. Columbia Journal of Gender and Law, 20(1), 201-384. Retrieved from https://cjgl.cdrs.columbia.edu/
• Forlan, N. (2016). Desired destinations of homeless women: Realizing aspirations within the context of homelessness. Creative Nursing, 22(3), 196-203. doi: 10.1891/1078-4535.22.3.196
• Petersen, A. S. (2013). ‘Why don’t they just get a job?’ Potential solutions for the chronically homeless. Townsend Letter, 354, 84-91. Retrieved from www.townsendletter.com
• Song, J., Ratner, E., Bartels, R., Alderton, D., Hudson, M., & Ahluwalia, L. (2007). Experiences with and attitudes toward death and dying among homeless persons. Journal of General Internal Medicine, 22(4), 427-434. doi: 10.1007/s11606-006-0045-8
• U.S. Centers for Disease Control and Prevention. (2018). Homelessness as a public health law issue: Selected resources. Retrieved from https://www.cdc.gov/
• U.S. Department of Housing and Urban Development (HUD). (2012). Homelessness. Retrieved from http://www.hud.gov/
• Verlinde, E., Verdee, T., Van de Walle, M., Art, B., De Maeseneer, J., & Willems, S. (2010). Unique health care utilization patterns in a homeless population in Ghent. BMC Health Services Research, 10(1), 242. doi: 10.1186/1472-6963-10.242
• Wilcox, K., Jojola, J. (2016). Incarcerating homeless costs city hundreds of thousands. 9NEWS.com. Retrieved September 30, 2018 from https://www.9news.com/article/news/local/investigations/incarcerating-homeless-costs-city-hundreds-of-thousands/354689220

Homeless People and the Barriers They Face

CSULB Research 594A

Consent Form

October 1, 2018

Who is collecting the data (e.g., agency)

The study is being conducted to learn about what obstacles homeless men and women face living on the streets in Los Angeles; making it difficult for successful transition off the street.

What will be done with the data

The data will be analyzed and used to develop better programs that help mitigate identified barriers to help men and women transition off the streets and into long term housing. This study is confidential. Confidentiality means that your responses to the survey will not be associated with your identity an any form. The consent form will be placed in a separate folder and placed in a separate locked file cabinet. The principal investigator of this study will be the only person who will have access to any of the identifying information.

Known or potential harm

There are no known or potential harm that the researchers expect. However, the questions that will be asked are personal in nature. Thus, participants may become uncomfortable with addressing the questions. The participant is free to not answer any questions that he/she may be uncomfortable in answering, at any time. The study is completely voluntary, and the participant may withdraw at any time. No penalty is associated with withdrawal from the study. Additionally, the participant may choose to take part in the study at a later time if he/she chooses.

Participant who chooses to complete the full study (complete the survey and all interview questions) will be compensated with a $20 food voucher

Invitation to take part in the Homeless People and the Barriers They Face

Your participation in this study would be very much appreciated.  If you have reviewed this consent form, understand its contents, and agree to participate in this study, please sign your name below.  If you are under 18 years old, a parent/guardian signature is necessary for you to participate in this study.

Participant’s Signature       Date

__________________________________     ______________________

Parent/Guardian Signature (if necessary)     Date