Thursday, April 25, 2019

Predicting and Preventing Chronic Homelessness

Source: The Economic Round table

All incidents of homelessness are not the same; in fact, much of it is short lived so approaching homelessness with a one-size fits all solution would be wasteful and ineffective. The majority of people who become homeless recover, often with little outside help, within a year. However, about 40% of people who become homeless stay homeless for at least a year or experience two or more episodes of homelessness within three years. So why do some people stay perpetually homeless while others find a way out? There are several factors that could explain the difference between these two populations. The chronically homeless have significantly higher rates of serious mental illness, physical disabilities, chronic physical illness, substance abuse, alcohol abuse, severe depression, PTSD, developmental disabilities and traumatic brain injuries. For instance, about 55% of chronically homeless persons have a serious mental illness compared to only 21% of those who escape homelessness within a year. About 39% of the chronically homeless have a physical disability compared to only 16% of those who experience short-term homelessness, and about 38% of the chronically homeless suffer from a chronic physical illness compared to only 16% of those who experience short-term homelessness. About 37% of the chronically homeless engage in drug abuse compared to only 14% of those who experience short-term homelessness. However as I explained in ‘Is Chronic Homelessness a Mental Health Problem’, while certain factors such as mental illness and substance abuse disorder are closely associated with chronic homelessness they are not necessarily the cause of chronic homelessness; these factors are both predictors and risk factors for chronic homelessness. The stressors of homelessness could actually result in these disorders that then reinforce homelessness. Having a method for differentiating between individuals who are likely to become chronically homeless and individuals who are likely to escape homelessness is the first step towards finding interventions that will reduce the chronically homeless population.

Predictive Model

A cohort study of the homeless population of Los Angeles county over a fifteen year period, conducted with a sample size of one million, assessed numerous risk factors for homelessness, and constructed a predictive model to estimate the probability of newly homeless individuals becoming chronically homeless. All low-wage workers are at risk of becoming chronically homeless if they lose their jobs but this risk varies depending on certain demographic characteristics; in particular, the risk is highest for low wage workers who are male, single and African American. A third of low-wage workers who become chronically homeless do so before they lose their job. A third also hold down jobs despite physical and mental impairments. These disabilities occur more often and become more debilitating when they lose their jobs. In general, people who become chronically homeless tend to have a history of job turnovers, underemployment and low wages. Providing comprehensive re-employment services, including education and job training, to low wage workers as soon as they lose their job would reduce the risk of chronic homelessness. Additionally, providing health care support to unemployed low wage workers with physical disabilities would improve their re-employment and job retention prospects. Chronically homeless individuals who have a criminal record and a history of substance and/or alcohol abuse will need behavioral health services or compulsory rehab along with legal services to expunge their record to gain re-employment prospects.

For young adults who enter adulthood homeless, the most reliable predictors of homelessness are six prior years of homelessness as an adolescent and prior time in foster care. Individuals who experience six prior years of homelessness as adolescents are three times as likely to experience homelessness as adults than individuals who were not homeless as adolescents. While only 5% of young adults come out of foster care, 13% of young adults who become chronically homeless come out of foster care. Additionally, homeless youth are more likely to be employed than their non-homeless counterparts but earn lower wages. Here too, education and job training programs would provide upward mobility.

The Public Incentive

Chronic homelessness is a taxpayer burden regardless of whether governments address it or not. Individuals who become chronically homeless have far higher public costs than non-homeless individuals. Healthcare costs are five times higher for chronically homeless workers and four times higher for chronically homeless youth than the general population. Justice system costs are nine times higher for chronically homeless workers and seven times higher for chronically homeless youth than the general population. Creating interventions tailored to meet the needs of people who have a higher risk of becoming chronically homeless will not only reduce the need for permanent supportive housing, but also reduce financial strain on local criminal justice and healthcare systems.

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