Bridges and Barriers to Housing for Homeless Street Dwellers: The Impact of Health and Substance Abuse Services on Housing Attainment

Author: Tatjana Meschede

Dissertation School: University of Massachusetts Boston

Abstract:

This indepth study of a cohort of chronically homeless street dwellers at risk of death will assess the effectiveness of medical and substance abuse services in connecting this group to the local homeless Continuum of Care (CoC) and permanent housing. Chronically homeless street dwellers have a variety of special needs that need to be attended to in order to enable them to move into any type of housing, most likely supportive housing. The Boston Health Care for the Homeless program identified a group of about 150 street dwellers in Boston at risk of death based on criteria identified in prior research and began an innovative model of providing primary care on the streets to this group. The effects of these homeless services combined with mainstream substance abuse services on housing outcomes are the focus of this project. Major research questions address the process by which chronically street homeless individuals connect with services and housing options, including enabling factors and barriers, and service outcomes, such as housing placements associated with medical and substance service use.

This dissertation project combines qualitative and quantitative data collection methods to strengthen the reliability and validity of findings. Specifically, existing databases on health and substance abuse service use and associated outcomes, including demographic information, will be merged and analyzed. A proposed data analytic model that hypothesizes positive outcomes (housing attainment, improved health status, reduced substance abuse) as a function of treatment retention (length of stay at a treatment facility and post treatment placements), service readiness (length of time in care, diagnoses, co-morbidities) and demographic characteristics will be tested. Quantitative data analyses will entail step-wise regression and step-wise logit analyses, and the usefulness of time series analysis will be explored.

In addition, structured interviews with service providers and service consumers will be conducted. Interviews with service providers will focus on their program's operation and service goals with respect to the street homeless, expected housing outcomes based on their services, their theories of why people live on the streets, and major obstacles and accomplishments in providing service to the homeless street population. Current members of the high-risk homeless street population will be interviewed on their homeless experience, service needs and service use, and their plans for leaving the streets and obstacles to doing so. Lastly, former members of the high-risk street population who are now residing in their own housing will be interviewed on their homeless experience, on how they managed to leave the streets as well as on their service needs and service use. Interview information will be analyzed using qualitative data analysis software.

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