research paper on homelessness in the united states

Homelessness and the Persistence of Deprivation: Income, Employment, and Safety Net Participation

Homelessness is arguably the most extreme hardship associated with poverty in the United States, yet people experiencing homelessness are excluded from official poverty statistics and much of the extreme poverty literature. This paper provides the most detailed and accurate portrait to date of the level and persistence of material disadvantage faced by this population, including the first national estimates of income, employment, and safety net participation based on administrative data. Starting from the first large and nationally representative sample of adults recorded as sheltered and unsheltered homeless taken from the 2010 Census, we link restricted-use longitudinal tax records and administrative data on the Supplemental Nutrition Assistance Program (SNAP), Medicare, Medicaid, Disability Insurance (DI), Supplemental Security Income (SSI), veterans’ benefits, housing assistance, and mortality. Nearly half of these adults had formal employment in the year they were observed as homeless, and nearly all either worked or were reached by at least one safety net program. Nevertheless, their incomes remained low for the decade surrounding an observed period of homelessness, suggesting that homelessness tends to arise in the context of long-term, severe deprivation rather than large and sudden losses of income. People appear to experience homelessness because they are very poor despite being connected to the labor market and safety net, with low permanent incomes leaving them vulnerable to the loss of housing when met with even modest disruptions to life circumstances.

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• Published: 25 April 2022

A qualitative systematic review on the experiences of homelessness among older adults

• Phuntsho Om 1 , 2 ,
• Lisa Whitehead 1 , 3 ,
• Caroline Vafeas 1 &
• Amanda Towell-Barnard 1  

BMC Geriatrics volume  22 , Article number:  363 ( 2022 ) Cite this article

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Adults who experience homelessness for an extended period of time also experience accelerated ageing and other negative impacts on their general health and wellbeing. Homelessness amongst older adults is on the rise, yet there are few systematic reviews investigating their experiences. Thus, this review classifies and synthesises qualitative research findings of studies published between 1990 to 2020 that have examined the needs and challenges of homeless older adults to elucidate their journey of homelessness. Seven papers met the requirements for inclusion. Three main themes were identified in the review: - (1) Pathways to homelessness, (2) Impact of homelessness, and (3) Outcomes and resolutions. This review collates current evidence on what is known about the experience of homelessness among older adults. In this study, homeless older adults identified a wide range of challenges associated with the experience of homelessness.

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The population globally is ageing. Although, ageing is truly a triumph of development, this demographic change presents both advantages and challenges. The concept of successful ageing is to “add life to years” rather than adding days to life and is about maximizing wellbeing and happiness for the older adult [ 1 ]. The risk of developing physical and mental health issues among older adults along with associated costs are linked to a higher demand for health and social care [ 2 ].

Theories on ageing have been developed with the goal of understanding the ageing process and how best to support “healthy ageing at home” and “ageing-in-place” [ 3 ] however these do not consider older adults who do not live in a supportive environment or adults who are homeless. The home setting can be a place associated with poor subjective well-being and some older adults may feel compelled to leave the home setting as a result [ 4 ].

There is no consistent definition of homelessness, rather it has been confined to socio-historical, geographical, and cultural contexts from which the term is drawn [ 5 ]. Homelessness can be defined by a range of categories: absolute and or hidden with homelessness defined as sleeping in parked cars or parks, in emergency shelters, or in temporary shelters (couch surfing) with no or minimal health and safety requirement standards, and risk to personal safety [ 6 , 7 , 8 ]. This includes people residing in sub-standard housing such, as single-room occupancy hotels, or cheap boarding houses, as well as low-cost tiny, lodgings with minimal amenities [ 9 , 10 ].

There is an increasing rise in homelessness among older adults and older homeless adults have been identified as the “new homeless”, a “forgotten group” and a “hidden group” [ 9 , 11 , 12 ].

The reasons for homelessness amongst older adults are diverse. These can include: the impact of natural disasters; the availability of affordable housing, including rising rental costs, a decline in social welfare and support programs; financial insecurity; a lack of social amenities; and increasing rates of mental health issues, combined with various addictions, including gambling [ 2 , 9 , 11 , 12 , 13 , 14 , 15 , 16 ]. In addition to this, family relationship breakdowns, or the death of loved ones, can cut people’s social connections, resulting in older adults experiencing homelessness for the first time. This displacement of older more vulnerable adults can lead to deprivation including the basic need for a place they can relate to as home, subsequently leaving them homeless [ 3 , 7 , 15 , 17 ].

Molinari, Brown and Frahm et al. (2013) found homelessness was unanimously perceived as a humiliating experience by homeless older adults [ 13 ]. According to a survey conducted by the United States Department of Housing and Urban Development, over 15% of 634,000 homeless individuals were 50 years or older, where the number of homeless people aged over 65 has been projected to double by 2050 [ 13 ]. The same survey reported that in the United States alone, adults as young as 50 years of age were facing challenges of homelessness, effectively accelerating ageing processes. Further to this, homeless older adults face a greater threat of age-related disease burden, where they are more likely to experience: functional, auditory, visual, and neurological impairments, frailty, emotional distress, and urinary incontinence, at higher rates than in the general community [ 18 ].

Similarly, van Dongen et al. have reported within a longitudinal cohort study, that older homeless adults, unlike their younger counterparts, reported a higher incidence of cardiovascular disease and visual problems, as well as reporting limited social support from family and friends or acquaintances, and limited medical or hospital care use in the past [ 19 ].

However, there is limited published research identifying the distinct needs of homeless older adults. This is a critical gap in the literature, where a deeper understanding of the experiences of older adults who have been or are currently homeless is required.

The main aim of this qualitative systematic review is to synthesise the evidence on the experience of homelessness of older adults.

Using Joanna Briggs Institute (JBI) guidelines, a meta-synthesis of global qualitative evidence was undertaken. Studies with titles and abstracts that met the analysis goals were retrieved and chosen, based on inclusion and exclusion criteria. These studies were further appraised to evaluate methodological validity by analysing evidence relevant to viability, appropriateness, meaningfulness, and effectiveness [ 20 ]. Qualitative and mixed-method studies with ample qualitative data in their results sections to allow secondary data analysis met the inclusion criteria. The sample comprised of older adults aged between 45 and 80 years that had experienced homelessness for at least one period. The search was restricted to studies that were published in English and available in full-text form, where studies with participants below 45 years, older adults in housing facilities, and aged care residents were excluded.

Search methods

This analysis followed the Joanna Briggs Institute (JBI) method for systematic reviews [ 20 ]. A qualitative assessment and review instrument (JBI-QARI 10 item tool) [ 20 ] was used to facilitate the meta-synthesis. Results from the studies were extracted, categorised, and synthesised. Searches were conducted in PsycINFO, Web of Science, Google Scholar, Medline, PubMed, and CINAHL using appropriate search terms. Additionally, important citations were searched from reference lists of relevant articles. Searches were limited to published studies from 1990 to 2020 (see Fig.  1 ).

PRISMA flowchart

Quality appraisal

Two reviewers independently assessed 21 articles for methodological quality in their design, conduct and analysis using the JBI-QARI 10 item tool [ 20 ]. Any discrepancies were discussed within the team. Out of the 21 articles, seven were included in the synthesis. Each selected study was re-read several times, discussed within the review team and data were abstracted for interpretation.

Data abstraction

Findings relating to both current and past experiences of homelessness among older adults were extracted from the seven selected studies. A total of 56 findings were extracted. Each finding was reviewed and further compared and manually coded to identify themes. Table  1 lists the author and year, sample size, design, setting, and participant characteristics of the selected studies.

Analysis of the seven reviewed articles was carried out using the qualitative evidence synthesis method [ 20 ] developed by JBI (2014). Qualitative findings from each study were first read and reread, followed by an identification of common themes. Recurring themes across studies were then grouped together in a meta-synthesis of the findings. This process comprised critical appraisal, data extraction, analysis, and a meta synthesis involving organisation and categorisation through decoding and encoding of the extracted data to produce a final summation of the findings. The qualitative evidence summation and synthesis were deliberated, cross-checked, and then reviewed by all the authors.

Of the seven studies identified for review (see Table 1 above), four studies directly explored pathways to homelessness amongst older adults. Individual study sample sizes ranged from 14 in Reynolds, et al. (2016) [ 21 ] to 60 in Viwatpanich (2015) [ 24 ]. Three studies applied in-depth face to face interviews, with three studies using semi-structured interviews, and one study conducting focus groups to collect data. The studies were conducted in three countries: Canada, USA, and Thailand.

Data synthesis commenced using open descriptive coding to search and identify concepts and finding relationship between them. Next using an interpretive process, the meaning units were categorised within each domain using labels close to the original language of the participants. The categorization of the data for each case was then followed by a cross-case analysis that examined the similarities and differences. Following categorisation, themes were conceptualised for each category. An overarching theme was identified: ‘the journey of homelessness’. Within this context, three core themes were identified: 1) Pathways to homelessness; 2) impact of homelessness; and 3) outcomes and resolutions, where each of these 3 themes had relevant sub-themes. (see Fig.  2 ).

The Journey of Homelessness Model

The conceptual model depicted in Fig. 2 represents the overarching theme of the ‘journey to homelessness,” and key concepts and relationships between variables from the synthesis of the literature. Unlike other conceptual models that involve causal and directional relationships, this model is both directional and non-hierarchical. The model illustrates the pathways to homelessness, the associated impacts of homelessness and the outcomes of homelessness. The following section explores the three themes and sub-themes in more detail.

Theme 1. Pathways to homelessness

The causes of homelessness were shown to be multifaceted, where pathways to homelessness revolved around a combination of individual, social, and structural factors. The reviewed data suggested that becoming homeless involved two distinct pathways: one that was gradual and one that was rapid.

Sub-theme 1.1: gradual pathway to homelessness

Findings from six studies contributed to this subtheme. This sub-theme captured the factors contributing to gradual pathways into homelessness amongst older people. These factors were identified as accelerated ageing, poverty, rising housing costs, failing and uncommitted social security systems, a lack of social programs and services, social distress, rural-urban migration, substance abuse and addiction, as well as estrangement from family or lack of living relatives [ 13 , 14 , 21 , 22 , 23 , 24 , 25 , 26 ].

The following quotations from these studies illustrate both estrangement from family and the impact of a lack of support from social services:

Many conflicts we had at that time, we never talked … never talked in normal way … nothing clear between us, emotion never came clear...they did not want to talk to me, not even to look at my face … I could not stand it, I surrendered. Beating and scolding by descendants is not in our tradition, no respect, if they did not want me to stay with them, I moved out [ 24 ] .

I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age [ 22 ] .

Personal vulnerability to difficult familial relationships, neglected needs and unstable housing were the most cited causes of homelessness amongst these older adults [ 3 , 9 , 14 , 25 ].

Two studies [ 15 , 21 ] described a pathway to homelessness as related to alcoholism and drug abuse, as highlighted in the following quotation:

I got into crack cocaine, I got into hooking, I got into anything you could think of I guess . . . So it was my addictions that brought me down, and unhealthy relationships [ 25 ] .

Feeling ‘homeless at home’ [ 27 ] due to loneliness was noted by some older adults as their reason for ‘living on the streets’. For example, homeless older adults that experienced social rejection and conflicts with housing management, neighbours, and roommates, noted this to ultimately lead them to homelessness. For example, one participant stated, “I have lived alone and never really felt at home, because to me home is a place that includes other people, your family” [ 23 ].

Sub-theme 1.2: rapid pathway to homelessness

Some older adults described the process of homelessness as ‘rapid’. A rapid pathway to homelessness was associated with abrupt life changes such as losing a loved one, divorce, and the impact of these losses on their lives. The two quotes below highlight rapid pathway process:

Losing them, let’s just say it evaporates over time. It’s the fact that I wake up like I am here that I can’t accept … homeless … in the street. I sold everything, every single thing! I never thought I’d end up like this. It’s like starting from zero [ 23 ].

I had a wife, then she died, I did not know where to go, what to do, I turned homeless [ 24 ] .

Older adults that faced a series of losses and a rapid deprivation of social support systems noted the experience of disrupted circumstances. Accordingly, they noted their fear of losing their independence and ‘sense of self’ resulted in their resistance to any help that was offered, in turn contributing to their homelessness.

Theme 2. Impact of homelessness

Findings from five studies contributed to this subtheme. Homelessness and ageing were presented to form a ‘double jeopardy’ where homelessness aggravated the challenges of old age [ 15 , 21 , 22 , 23 , 24 ].

This theme included the subthemes of: unmet needs, coping strategies, and the realities of housing availability.

Sub-theme 2.1: unmet needs

‘Unmet needs’ amongst older homeless adults were categorised as involving physical, emotional and social needs leading to despair and destitution. As this quote below highlights:

I’m supposed to get a pneumoscopy, but where am I, where do I stay? How can they get a hold of me? I don’t have money to get around [ 15 ] .

Sub-theme 2.1.1: lack of physical wellbeing

Findings from six studies [ 14 , 15 , 18 , 21 , 22 , 24 ] contributed to this subtheme. Physical decline and physical disability were described as exacerbated by the experience of being homeless. Participants described a relationship between age and frailty, fatigue, poor physical health, and impaired mobility while homeless, as these quotes demonstrate:

Ah! Walking all day, for me, it’s very hard on the body, ok. Sleeping outside on a park bench, that’s very, very hard on the body. The bones, the humidity. Just leaving in the morning and then not going to work. … You’re always faced with the outdoors, and always faced with walking, walking. It’s not easy walking from downtown [ 15 ] .

My health was very poor. I was very prone to pneumonia. I was taken out of the shelter in the ambulance and it was later determined that I had actually contracted tuberculosis [ 22 ] .

At that time, I got Psoriasis, I knew that it was disgusting … . It looked scary. I am much too old. It is so difficult to find a job … nobody needed me … so I decided to stay and sleep here [ 24 ] .

Homelessness in later life was shown to often be linked to a multitude of health problems. Most studies described older homeless people as living with physical health problems including chronic diseases such as hypertension, diabetes, bone and joint diseases, respiratory illness, and skin diseases [ 14 , 21 , 22 ]..

Sub-theme 2.1.2: lack of emotional wellbeing

Findings from five studies contributed to this subtheme. Accordingly, homelessness was described as contributing to poor emotional health related to social exclusion and isolation amongst older adults. Further, homelessness was associated with cognitive impairment, stigma, shame, stress and anxiety, as well as depression amongst homeless older adults [ 15 , 21 , 24 , 25 ]. Homelessness was described as a humiliating and degrading experience, as evident in these quotes:

At my age, I don’t see life ahead of me anymore. You see, I don’t know, I don’t see the end of the tunnel, … … It’s as if I wanted to erase myself [ 15 ] .

All I could think about was suicide. How did I end up here? When I think a lot to myself, what the hell am I doing? [ 23 ] .

Feelings such as shame, demoralisation, and loss of dignity were described and these impacted on emotional health.

Opportunities to improve emotional wellbeing were rarely described, however one example stood out as an exception and this was related to volunteering:

One thing I didn’t expect was when I helped people with whatever issues they were having on their bicycle, I really enjoyed that. It gave me a chance to teach someone [ 25 ] .

Examples such as these were rare, with social exclusion and the lack of opportunity to contribute and connect with others more commonly described.

Sub-theme 2.1.3: lack of social relationships

Findings from four studies contributed to this subtheme. Social relationships were described as central to creating a life that had meaning and familial interactions. Disconnection from loved ones was associated with feelings of unhappiness [ 13 , 15 , 27 ], while companionship was shown to improve wellbeing [ 25 ]. Social relationships were shown to decline, leading to the experience of social exclusion and isolation.

I am a walking dying woman. I walk until I can’t walk anymore, and then I sit. The busses pass me by. We are untouchables and I do not think anybody’s going to do anything about it [ 25 ] .

At my age, I don’t see life ahead of me anymore. Because everywhere I go: “Ah! He’s homeless.” It is as if I wanted to erase myself. I think that it’s more “society,” as such, that rejects homeless people [ 15 ] .

I think that living homeless, you exclude yourself, and a lot of other people exclude you. I was on the other side before becoming homeless. So, you know, the perception that people have, it plays a big part. … So that together makes it so that, if you don’t have family either, let’s say, you don’t have … close friends or a strong social network. Well, you experience all that, you live with loneliness and isolation [ 15 ] .

Sub-theme 2.2: impaired coping strategies

Findings from four studies contributed to this subtheme. Older homeless adults described a range of factors as impacting their ability to cope. These included moving to shelters, challenges to adapt to their unique requirements, limited housing options, limited income supports, social exclusion, isolation, and a lack of coordination and access to community health and support services [ 13 , 15 , 23 , 25 ].

As the quote below shows, there were expressions about the fear of homelessness and how long it will last:

Struggling to get your basic needs met, scrounging, just trying to get by as best I can, and feeling desperation, humiliation, despair, a shocking feeling, full of fear, and turmoil. What’s tomorrow gonna bring? Why am I in this situation? How do I get out of it? [ 13 ]

Coping with the harsh realities of homelessness in later life was described as being increasingly challenging for most older adults because older homeless individuals experience mental health disorders and acute or chronic physical illnesses.

Sub-theme 2.3: realities of housing availability

Findings from three studies [ 13 , 15 , 23 ] described the challenges experienced in accessing housing services and fulfilling requirements for safe, secure, and affordable housing. This theme captured impacts of poor coordination and communication between homeless veterans and housing intervention providers in regard to information for service availability, gaining access to homeless shelters and a lack of training and education by some housing providers especially with regard to homelessness.

He … got this rule book and threw it at me. Find a place! [ 13 ]

You know, I’m 60, I’m not 20 anymore. So that’s what makes you tired, you get stressed. So, after that, they give you pills as a solution. I told the doctor, sorry I didn’t come here for pills, I came for housing [ 23 ] .

I submitted applications for low-income housing, I’ve been on the waiting list, seven years is a long time, especially at my age [ 23 ] .

I want a space where I can be well. I wasn’t well when I was young. I’ve never been well anywhere. I need a simple place … where I can have peace, and quiet … but not be all alone [ 15 ] .

Older homeless adults described a need to create stability and escape homelessness through the provision of services, and in particular, housing. Older adults described how oscillating in and out of shelters prevented senses of safety, stability, or autonomy.

Theme 3. Outcomes and resolutions

In four studies [ 13 , 15 , 21 , 24 ] homeless older adults described how the outcomes and resolutions of homelessness involved overcoming both complex challenges and habituations. This theme encompassed the finding of directions and strengths to improve difficult situations and overcome challenges that occurred at the intersection of homelessness and ageing.

Three subthemes were identified within this theme: building resilience, strength, and hope; seeking spiritual meaning; and exiting the cycle of homelessness.

Sub-theme 3.1: exiting the cycle of homelessness

Some older adults moved out of the phase of homelessness and described facilitators and barriers to this transition whilst other described choosing to stay homeless until the end of their lives.

Sub-theme 3.1.1: factors facilitating the exit

Two studies [ 13 , 15 ] contributed to this sub-theme, where older adults described means of overcoming challenges and establishing priorities in order to exit homelessness in later life. The results suggested that the creation of autonomy, flexibility, and privacy helped people feel belonging and often this meant living in a place where they could continue to drink and/or occasionally use drugs, have access to a health system to manage health problems; and have access to food and shelter facilitated exits.

They listen to you and they help you with . . . your transition, your program. You sit down and you work the program out with them;” “If you have a question, you can walk in anytime and ask them what’s going on [ 13 ] .

In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come [ 15 ] .

Fulfilling financial support, housing and health care services was identified facilitate older adults exiting homelessness.

Sub-theme 3.2: remaining homeless

Some older adults experienced homelessness at a younger age and described continuing to be homeless in older age, where they oscillated between living in shelters and on the streets.

I am used to being in this way, moved from place to place … me alone, without father and mother since childhood … it become normal and I feel happier, than to stay with others [ 24 ] .

It’s just a continual cycle. I just got sucked down into it, you know. It’s hard to describe because when I found myself there, I was just like, wow. How did I get here? [ 21 ]

Participants described the chronic nature of homelessness as involving a challenge of disentangling themselves from the cycle of homelessness. A lack of tailored intervention programs to respond to homelessness in later life also prevented older adults from exiting homelessness.

Sub-theme 3.2.1: perceived barriers to exiting homelessness

In two studies [ 21 , 24 ], older adults described experiences of vulnerabilities and challenges to exiting homelessness. Shelters were described as constraining and not being able to adapt to the unique needs of older adults. Where limited housing options were seen as available, income supports were described as limited, with a lack of coordinated and, accessible community health and social support services, impacting on participants’ ability to ‘feel in place’.

My health pretty much stayed the same as when I was homeless. The conditions I have aren't gonna improve [ 22 ] .

It’s harder to keep a place, especially when you keep falling back in the same circle and you’re in the same crowd. I am finding out today, you keep falling back in the same circle, the same circle is not gonna change [ 21 ] .

One participant described the difficulty of obtaining employment as a barrier to exiting homelessness:

You know being 50 years old, it’s going to be really difficult to be able to reintegrate into the workforce [ 21 ] .

Housing facilities and transition to housing shelters were shown to present challenges for homeless older adults. A lack of privacy, autonomy, rigid rules, and challenging interpersonal relationships within housing and shelter programs were identified as leading older adults to feel homeless at home.

Sub-theme 3.3: building resilience and strength

This sub-theme captured the life lessons, resilience, strength, and hope of older homeless adults, described as having formed through experiences and skills developed whilst living on the streets. This theme also suggests how individuals cope with difficult symptoms related to social support and, addiction, relying on positive things learned while living with other homeless people on the streets. Some older adults chose to stay homeless accepting homelessness as their fate.

In the next couple years, I hope to find myself an apartment for the few good years I have left, before the big pains of “aging” come. I really want a normal life, get up in the morning, go to work, think about vacation. Hang out with other people … I don’t have a girlfriend but would like to start a life with someone else [ 15 ] .

What does ageing mean to you, getting older on the streets? A: Experience. Q: Ok. A: Wisdom. Q: Getting older on the streets, that’s how you see it, it’s the wisdom that you have gained. A: Yeah, that’s where I learned to be wise. Because there are several people who told me I am wise [ 15 ] .

I think because of karma … I accept it as punishment from bad deeds in my former life, but only in this life okay! Next life I am looking forward for a normal life, like others [ 24 ] .

Most studies [ 3 , 8 , 13 , 17 ] cited that wisdom, experience, and optimism were necessary in order to help older adults exit homelessness. Optimism instilled future hope and self-worth back into the self-esteem of homeless older adults.

Sub-theme 3.3.1: seeking spiritual meaning

In two studies [ 24 , 25 ], older adults described finding meaning in life through adopting and accepting religious faith with a belief to achieve higher self-actualisation.

I want to be closer to Dhamma (Buddhist teaching), I want to be a monk till I die [ 24 ] .

Meditate, just being by myself. Living the night, just being alone and listening to my music, that makes [my pain] feel better. I like jazz but I just listen to my music, just go away to myself. That makes me feel - I like being alone. I love being alone [ 25 ] .

When I feel [anger over my situation] I go to the water and I pray hard. I just start praising God until I can feel the spirit come over me to comfort me. I pray until He comes and allows his spirit to wrap his arm around me; I feel a lot better. A psychiatrist can’t tell me what’s wrong with me. For someone to try to help would mean a lot. I do not have nobody but to trust God. He’s my only psychiatrist [ 25 ] .

Homeless older adults recognised and confirmed that psychosocial and existential symptoms caused as much distress as physical symptoms triggering negative changes in personality, energy, and motivation. Some homeless older adults viewed their age as a source of strength, wisdom, and experience in learning to manage their symptoms, describing themselves as survivors who had overcome significant hardships. Higher levels of wellbeing were likely to be achieved when older people sought spiritual meaning through religion, socialising, reading, meditating, volunteering, and introspection practices.

This review synthesised evidence generated from qualitative studies to provide a glimpse into the experiences of homeless older adults. The review has shown that while drivers related to entry into homelessness were diverse, two distinct trajectories underpinned the experience of becoming homeless amongst older adults. Older people that faced a sudden series of losses that completely overturned their circumstances fell into the ‘rapid pathway’ to homelessness. Participants on a ‘gradual pathway’ were shown to become homeless due to a range of factors, for example - addiction problems, physical and mental health issues, relationship break-ups, foster care, poverty, unemployment, and greater housing instability [ 13 , 24 ]. Further to this, homeless older adults were shown to include a significant percentage of separated, divorced, or single individuals [ 28 ]. Likewise becoming single in later life was shown to be associated with homelessness amongst older people. Other studies found that ageing, its associated factors and a lack of stable housing were prominent reasons for homelessness [ 15 , 22 , 23 ].

Housing was perceived to offer a sense of security and a stable environment conducive for safe ageing. Further, housing was identified as offering protection from harsh weather and other dangers. Similar accounts relaying how the health of homeless older adults declined during episodes of homelessness was also reported [ 9 ]. Stable housing played an influencing role in physical health and general wellbeing. Although homeless older adults expressed satisfaction with life, they linked secure housing with healthy dietary habits, proper sleep patterns, enhanced self-care and reduced feelings of stress and anxiety [ 22 ]. In addition, this review found that most homeless older adults were more able to prioritise their health care needs when other necessities such as food and shelter were met. However, research has also suggested that living in scattered-site apartments can reinforce the process of social exclusion, and thus they are not appropriate for older adults living alone, with regard to their additional health and social needs [ 3 , 10 , 28 ].

Ageing intensified the adversities of homelessness experiences and presented a twofold risk where homelessness aggravated the challenges of old age and vice versa [ 15 ]. Old age and its associated conditions intensified older adults’ perceptions of homelessness later in life, including feelings of shame, anxiety, and worry. Studies by Cohen [ 9 ], Kwan, Lau and Cheung [ 29 ], and Molinari et al. [ 13 ], have unanimously shown older adults to perceive homelessness as a dehumanising experience. Homelessness was described as: struggling “to get your basic needs met,” “scrounging, just trying to get by as best I can,” and feeling “desperation,” “humiliation,” “despair,” “a shocking feeling,” “full of dread, turmoil,” “what will tomorrow bring? why am I in this predicament and how can I get over it?” [ 13 ]. For most participants, homelessness was not a preferred option.

The limitations of this review include the predominance of data collected in North America which may reduce the generalisability of the findings. Another drawback is that it presents only a cursory review of issues related to gender, race, and ethnicity. Finally, the qualitative data analysis applied by the majority of studies here is subjective, where outcomes could be affected by authors’ personal biases.

Despite these limitations, the review has conceptualised two divergent pathways into homelessness in later life, as well as the impacts of homelessness, drawing attention to a greater understanding of homelessness experienced by older adults.

The review sought to provide insight into the needs of homeless older adults. Awareness of the complexities faced by homeless older adults need to be acknowledged if policy and research are to support the population and improve access to resources and support. The review has highlighted areas for future research to expand knowledge and understanding of the unique needs and challenges of homeless older adults.

Synthesis of seven studies resulted in the identification of an overarching theme relating to the ‘journey of homelessness’ and three major themes, each with subthemes, to describe older adults’ experiences of homelessness. A broad range of diverse settings, cultures, and countries with a particular focus on homelessness in later life were included. The review has revealed homogeneity of experiences amongst homeless older adults, with the need for access to appropriate and affordable housing and adequate support systems.

The findings have identified pathways to homelessness require different prevention and support measures. People in the study who described a gradual pathway needed social support to address distress, which might have helped them avoid losing their homes. Those individuals with rapid pathways unanimously concluded that homelessness could have been avoided if independence and self-sufficiency were less regarded as a norm by society.

Availability of data and materials

The authors declare that all data generated or analysed during this study are included in this published article.

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Acknowledgements

We would like to acknowledge Lisa Webb, Librarian, Edith Cowan University Library for her support in the literature search and Dr. Michael Stein, HDR Communication Advisor, Edith Cowan University for editing.

There are no separate funding source for this review as it is part of my full-time PhD study with the School of Nursing Midwifery, Edith Cowan University.

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Phuntsho Om, Lisa Whitehead, Caroline Vafeas & Amanda Towell-Barnard

Faculty of Nursing and Public Health, Khesar Gyalpo University of Medical Science of Bhutan, Thimphu, Bhutan

Phuntsho Om

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PO, LW, CV, and ATB substantially contributed to the conception and design of the article. All authors critically appraised the searched literature, discussed each item in the appraisal instrument for each study included in the review and interpreting the relevant findings. The primary author PO drafted the article and LW, CV and ATB revised it critically for important intellectual content. The author(s) read and approved the final manuscript.

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The study was classified as exempt from ethical review approved by the Human Research Ethics Committee of Edith Cowan University. All material included in this review are in the public domain and not applicable as it is a review article. Accordance: We declare that this systematic review was conducted in accordance with Joanna Briggs Institute (JBI) method for systematic reviews using the qualitative assessment and review instrument (QARIs) to facilitate the meta-synthesis. This review was followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) (2009).

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Om, P., Whitehead, L., Vafeas, C. et al. A qualitative systematic review on the experiences of homelessness among older adults. BMC Geriatr 22 , 363 (2022). https://doi.org/10.1186/s12877-022-02978-9

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• Homelessness
• Older adults
• Health and wellbeing
• Qualitative
• Systematic review

BMC Geriatrics

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Data Sources That Enumerate People Experiencing Homelessness in the United States: Opportunities and Challenges for Epidemiologic Research

• PMID: 33751025
• DOI: 10.1093/aje/kwab051

Homelessness is associated with a multitude of poor health outcomes. However, the full extent of the risks associated with homelessness is not possible to quantify without reliable population data. Here, we outline 3 federal, publicly available data sources for estimating the number of people experiencing homelessness in the United States. We describe the appropriate uses and limitations of each data source in the context of infectious disease epidemiology. These data sources provide an opportunity to expand current research and develop actionable analyses.

Keywords: data sources; denominator data; homelessness; population data.

Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health 2021. This work is written by (a) US Government employee(s) and is in the public domain in the US.

• Datasets as Topic*
• Epidemiologic Studies*
• Ill-Housed Persons*

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USICH Releases First Federal Homelessness Research Agenda in More Than a Decade

What would it take to prevent and end homelessness?  

While decades of research have documented effective strategies for helping people exit homelessness (particularly Housing First and Critical Time Intervention),  more research is needed  to better understand how to scale housing and supportive services. And while communities are increasingly focused on homelessness prevention (including guaranteed basic income, flexible funding pools, and shelter diversion),  the research remains limited . 

Today, USICH published   From Evidence to Action — the first federal homelessness research agenda in more than a decade —to shape federal investments in homelessness research and offer a roadmap for academic researchers, philanthropy, students, and others committed to understanding what works to prevent and end the crisis of homelessness in the United States.

This agenda—which will evolve over time—was  developed with significant public input  from researchers, people with lived experience of homelessness, national organizations, and experts from federal agencies. 

“We are excited to release this important resource today. While much excellent research has been done in recent years to point the way to effective solutions, more is needed,” said USICH Executive Director Jeff Olivet. “ From Evidence to Action will not only help us build a stronger base of evidence for ending homelessness, but it will also push us to make sure that federal, state, and local work to prevent and end homelessness is grounded in data and evidence rather than gut feeling, intuition, and myths about why people are homeless.”

From Evidence to Action  seeks to:

• Strengthen our nation’s collective base of knowledge on what works to prevent and end homelessness through rigorous qualitative and quantitative evidence
• Reinforce existing evidence to combat disinformation
• Align research priorities and prevent fragmentation at both the federal and non-federal levels
• Facilitate meaningful engagement of and collaboration with a diverse group of funders, researchers, people with lived expertise, and partners at every stage of developing and implementing federal research activities
• Promote research to address gaps in policy and practice, and facilitate the uptake of evidence by decision makers and service providers
• Catalyze governmental and non-governmental investment in homelessness research

The agenda focuses on the following topics:

Preventing Homelessness

• Universal Prevention
• Targeted Prevention
• Screening and Identifying Risk
• Cost and Scale

Ending Homelessness 

• Cost  
• Longitudinal Outcomes
• Housing and Services
• Specific Subpopulations
• Unsheltered Homelessness
• Lessons Learned From COVID-19 Response

Click to read  From Evidence to Action: A Federal Homelessness Research Agenda.

For more information, visit usich.gov/research .

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In addition to grant programs relevant to homelessness, the Department of Health and Human Services also works to advance research in this field. The Department funds the development of a range of research projects to aid providers and policymakers in better understanding and addressing the issues facing people experiencing homelessness.

Resources from the CDC on People Experiencing Homelessness and COVID-19, Centers for Disease Control and Prevention

Homelessness Research, Office of Planning, Research, and Evaluation, Administration for Children and Families

Homelessness Research, Office of the Assistant Secretary for Planning and Evaluation

Homelessness Among People Living in Encampments (Conducted in partnership with HUD) As of 2019, homeless encampments were appearing in numbers not seen in almost a century. To learn more about encampments and cities’ approaches in responding to them, Abt Associates conducted the study Exploring Homelessness Among People Living in Encampments and Associated Costs for the U.S. Department of Health and Human Services and the U.S. Department of Housing and Urban Development (HUD). After completing a literature review, the study team selected nine cities currently responding to encampments to participate in telephone interviews in early 2019. Findings from this study – the report on costs, individual site summary reports, and the literature review – are intended to help federal, state, and local policymakers and practitioners understand the nature of encampments, strategies for responding to encampments, and the costs associated with those approaches.

Health Conditions Among Individuals With a History of Homelessness This paper uses a proprietary data set with electronic health records of more than 54,000 individuals with ICD-10 code of homelessness between 2015 and 2019. The paper found that for many chronic conditions, people with a history of homelessness have a greater prevalence than a comparison cohort of individuals matched on age and gender. In addition, the cohort with a history of homelessness had twice the rate of ever having head injuries and high rates of viral hepatitis, alcohol abuse, and opioid abuse.

Comorbid Health Conditions and Treatment Utilization among Individuals with Opioid Use Disorder Experiencing Homelessness People experiencing homelessness have been particularly hard hit by the opioid crisis. This epidemic has also impacted individuals experiencing homelessness in ways that are distinct from how it has impacted individuals with stable housing. However, not much is known about comorbid health conditions and health services utilization among adults with opioid use disorder (OUD) who are experiencing homelessness. A retrospective observational cohort study was conducted utilizing a large national all-payer electronic health record database, finding that underlying mental health conditions and polysubstance use contribute toward making individuals experiencing homelessness more susceptible to adverse health outcomes associated with OUD. Health policy initiatives directed toward treatment engagement might benefit from an emphasis on addressing housing instability that many individuals with OUD might be experiencing.

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Individuals Experiencing Homelessness Are Likely to Have Medical Conditions Associated with Severe Illness from COVID-19 This paper is a descriptive analysis of the prevalence rates of some chronic health conditions that are associated with a higher risk of severe illness from COVID-19 among people with a history of homelessness. It uses a proprietary dataset with electronic health records of 61,180 individuals with an ICD-10 code of homelessness between 2015 and 2019. The paper finds that many of the health conditions examined (those believed to be linked to higher risks of severe illness from COVID-19), people with a history of homelessness have greater prevalence than the general population. People with a history of homelessness have comorbidities that impact their health in multi-faceted ways.

Housing Models that May Promote Recovery for Individuals and Families Facing Opioid Use Disorder This project describes the housing models available for individuals with opioid use disorder (OUD) who experience housing instability or homelessness. The association between OUD and homelessness has been examined and established. To better understand housing models that may support those with OUD, the study team conducted an environmental scan and held discussions with experts and providers in four communities.

Behavioral Health Improvements Over Time among Adults in Families Experiencing Homelessness The Behavioral Health Improvements Over Time among Adults in Families Experiencing Homelessness brief explores parents’ behavioral health at the time the family was in emergency shelter and at 20 and 37 months after experiencing homelessness. This brief examines psychological distress, alcohol dependence, drug abuse, and symptoms of post-traumatic stress disorder; examines what family characteristics and experiences prior to shelter were associated with behavioral health problems and changes over time; and examines the relationship between housing instability and behavioral health 37 months after a shelter stay.

Employment of Families Experiencing Homelessness The Employment of Families Experiencing Homelessness brief explores parents’ earnings at the time the family was in emergency shelter, prior to becoming homeless and at 20 and 37 months after experiencing homelessness. This brief examines employment rates, compares the employment rates of families experiencing homelessness to the employment rate of parents in deeply poor families in the same communities, discusses barriers parents identified for not working, and explores the relationship between employment, income, and continued housing instability.

Child Separation among Families Experiencing Homelessness The Child Separation among Families Experiencing Homelessness brief explores child separations among families experiencing homelessness. It builds upon the fourth brief in this series, “Child and Partner Transitions among Families Experiencing Homelessness,” which looked at family separations and reunifications in the 20 months after being in emergency shelter and the association between family separation and recent housing instability following an initial shelter stay. This brief provides a more detailed examination of these families and their children before and after the initial shelter stay, revealing more extensive and persistent levels of child separation. It gives detailed characteristics of separated children and examines whether future child separation after a shelter stay is related to either housing instability of previous separations.

Child and Partner Transitions among Families Experiencing Homelessness This research brief takes advantage of data collected for the Family Options Study, sponsored by the U.S. Department of Housing and Urban Development. This brief examines the extent to which parents were separated from their children or adult partners, including spouses,1 during a stay in emergency shelter and whether they experienced additional separations or reunifications in the 20 months following the shelter stay. It also considers whether family separations while in shelter are associated with additional housing instability following the shelter stay, as well as whether continued housing instability is associated with subsequent family separations.

Well-being of Young Children after Experiencing Homelessness This research brief takes advantage of data collected for the Family Options Study, sponsored by the U.S. Department of Housing and Urban Development. High-quality early education and care arrangements have been linked to gains in school readiness for children in low-income families, but less is known about its influence on children who have experienced homelessness. This study examines the extent to which children are enrolled in Head Start and other early education and center-based care programs 20 months after a shelter stay, as well as whether continued housing instability after a shelter stay is related to enrollment rates and stability of care arrangements. The study then examine whether there is evidence of relationships between Head Start and other early education and center-based care enrollment and children’s school readiness and behavioral challenges.

Pretesting a Human Trafficking Screening Tool in the Child Welfare and Runaway and Homeless Youth Systems Despite the fact that youth involved in the child welfare (CW) and runaway and homeless youth (RHY) systems are particularly vulnerable to being trafficked, there is no consensus screening tool to identify trafficking experiences among such youth. In order to better serve youth trafficking victims, this study developed a Human Trafficking Screening Tool (HTST) and pretested it with 617 RHY- and CW-involved youth. This research established that the screening tool is accessible to youth and easy to administer, and that both the full-length tool and a shorter version were effective in identifying youth who are trafficking victims in RHY and CW systems, though additional research with more youth is needed.

Patterns of Benefit Receipt among Families who Experience Homelessness This brief uses data collected for the U.S. Department of Housing and Urban Development’s Family Options Study to analyze patterns of receipt of TANF cash assistance, SNAP food assistance, and publicly funded health insurance benefits among these families, with a focus on the characteristics of those receiving and not receiving benefits. The brief: Examines whether family characteristics, including age, marital status, and demographic characteristics relate to benefit receipt; Explores the relationship between benefit receipt and housing instability following an initial shelter stay; and examines whether help accessing benefits is related to families’ TANF receipt

Final Report – Street Outreach Program Data Collection Study This first-of-its-kind study focused on 873 youth ages 14 to 21 in 11 cities. Respondents included street youth receiving services from ACF’s Street Outreach Program grantees and street youth who were not currently using services from SOP grantees. Study findings include that: nearly half of respondents became homeless for the first time because they were asked to leave home by a parent or caregiver; more than half have tried to stay at a shelter but found it full; the average youth had spent nearly two years living on the street; and nearly 30 percent identified as lesbian, gay, or bisexual, and nearly 7 percent identified as transgender.

Are Homeless Families Connected to the Social Safety Net? This analysis of HUD's Family Options Study data shows that families in a shelter and 20 months later are generally connected to public benefits at similar rates to other families in deep poverty. This non-experimental analysis finds that homeless families receive TANF, publicly funded health insurance (including Medicaid, CHIP, and state-funded insurance), and SNAP at equal or greater rates than other families in their communities who are also living in deep poverty.

State Strategies for Coordinating Medicaid Services and Housing for Adults with Behavioral Health Conditions This Issue Brief describes the strategies used by four states--Louisiana, Massachusetts, Tennessee, and Illinois--to improve the link between Medicaid and housing services for adult Medicaid beneficiaries with behavioral health conditions. This brief does not assess the success of these strategies, but instead focuses on the mechanisms the states are using to improve care coordination for individuals with both behavioral health and housing needs. Federal and state policymakers and other stakeholders can use this information in developing their own initiatives.

Improving the Coordination of Services for Adults with Mental Health and Substance Use Disorders: Profiles for Four State Medicaid Initiatives In 2013, ASPE contracted with Mathematica Policy Research to conduct case studies of the financing arrangements and delivery models that states are using to improve the coordination of care for Medicaid beneficiaries with mental health and substance use disorders in four states: Illinois, Louisiana, Massachusetts, and Tennessee. This report profiles and describes the key elements of the strategy used in each state, including the financing mechanisms, state-level and local-level partnerships, use of data and information systems, and efforts to improve coordination with housing. Moreover, the case studies sought to describe the "on-the-ground" operation of the care coordination models from the perspectives of providers, consumers, and other stakeholders. Although these case studies do not evaluate the effectiveness or outcomes of the strategies used in these states, policymakers, managed care organizations, providers, and other stakeholders may wish to consider the components of these strategies in their own efforts to improve care coordination.

State Strategies for Improving Provider Collaboration and Care Coordination for Medicaid Beneficiaries with Behavioral Health Conditions This Issue Brief highlights the efforts of four states--Illinois, Louisiana, Massachusetts, and Tennessee--to facilitate provider-level coordination for Medicaid beneficiaries with behavioral health disorders. It describes the financing strategies and specific mechanisms that states are using to improve care coordination. It summarizes some of the key ingredients of these efforts as reported by providers, consumers, agency representatives, and managed care companies in the four states. This information may be useful to federal and state policymakers and other stakeholders as they develop their own initiatives.

"Homeless Caseload is Associated with Behavioral Health and Case Management Staffing in Health Centers"    [Journal Article authored by analysts at ASPE and SAMHSA)] This paper examines organizational characteristics and staffing patterns in FQHCs with large homeless caseloads. Regardless of whether each health center received targeted Health Care for the Homeless funding, health centers with high homeless caseloads were more likely to have high behavioral health and enabling services staffing—indicating that health centers tailor their staffing mix to the needs of their patients. The study also found that rural health centers had lower levels of behavioral health and enabling services staffing, highlighting the need to monitor disparities, link health centers with technical assistance on partnering with community-based behavioral health providers, and emphasize co-locating behavioral health services through grant oversight mechanisms.

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Emerging Practices From the Field (Assistant Secretary for Planning and Evaluation) This report describes existing practices in the field of communities currently serving homeless and formerly homeless individuals as Medicaid beneficiaries.

Building Partnerships to Address Family Homelessness Around the country, Head Start and Early Head Start programs are building partnerships in their communities in order to make their services more accessible for children experiencing homelessness. This resource paper highlights the work being done by local Head Start and Early Head Start programs to connect with public housing associations, emergency shelter providers, local education agencies, and other community service providers. It also provides recommendations and resources to facilitate collaborations in other communities.

Promising Practices for Children Experiencing Homelessness: A Look at Two States This resource paper highlights work to create interventions that are specifically targeted at increasing access to high-quality early care and learning programs for children experiencing homelessness. It provides an overview of the effects of homelessness on young children, reviews federal initiatives that have expanded access to early care and learning for this population, looks at how two states - Massachusetts and Oregon - have implemented innovative policies to improve early childhood outcomes for this group, and presents recommendations for how other states can develop their own interventions.

Identifying and Serving LGBTQ Youth: Case Studies of Runaway and Homeless Youth Program Grantees To better understand provider experiences serving lesbian, gay, bisexual, transgender and Questioning (LGBTQ) runaway and homeless youth, this study reports on case studies of four local agencies receiving grants from the Administration for Children and Family’s Runaway and Homeless Youth (RHY) Program. The purpose of the study was to learn about programs’ strategies for identifying and serving LGBTQ RHY, the challenges programs face in understanding and addressing the needs of this population, and potential areas for future research.

Promoting Protective Factors for In-Risk Families and Youth: A Brief for Researchers    (Administration for Children and Families) This report explores the factors that make children and young people more able to cope with the trauma they face. It focuses on five populations that are often victimized the most: infants, children, and adolescents who are victims of child abuse and neglect; runaway and homeless youth; youth in or transitioning out of foster care; children and youth exposed to domestic violence; and pregnant and parenting teens.

Housing for Youth Aging Out of Foster Care (U.S. Department of Housing and Urban Development, with HHS’ Assistant Secretary for Planning and Evaluation) This research project focused on the housing needs of the over 25,000 youth who “age out” of the foster care system each year. It explores and documents the range of housing options available to these youth, includes an in-depth review of communities using the Family Unification Program (FUP) vouchers, identifies opportunities to mitigate the risk of homelessness for youth as they transition from the foster care system, and suggests areas for future research.

Housing Assistance and Supportive Services in Memphis: Best Practices for Serving High Needs Populations This standalone document from the Housing Assistance and Supportive Services in Memphis project synthesizes the literature and recent research on how to provide services to people in HUD-assisted housing.

Linking Human Services and Housing Assistance for Homeless Families and Families at Risk of Homelessness    (Assistant Secretary for Planning and Evaluation) This final report presents findings from the Linking Human Services and Housing Supports to Address Family Homelessness project. Through in-depth, on-site case studies, this study observed 14 communities that coordinate federally funded housing supports and comprehensive services to more effectively serve homeless families and families at risk of becoming homeless. Seven of the models include participation from local public housing agencies (PHAs). The report includes information about the structure of the programs examined, common promising practices identified across the models, and detailed case studies of the 14 models.

Establishing Eligibility for SSI for Chronically Homeless People    (Assistant Secretary for Planning and Evaluation) This issue paper describes innovative approaches to establishing SSI eligibility.

Health, Housing, and Service Supports for Three Groups of People Experiencing Chronic Homelessness  (Assistant Secretary for Planning and Evaluation) This issue paper describes three subgroups of the people experiencing chronic homelessness, and the services and housing configurations currently supporting them.

Public Housing Agencies and Permanent Supportive Housing for Chronically Homeless People    (Assistant Secretary for Planning and Evaluation) This issue paper looks at innovative ways that public housing agencies are supporting housing for formerly homeless people in the communities the researchers visited.

Medicaid Financing for Services in Supportive Housing for Chronically Homeless People: Current Practices and Opportunities    (Assistant Secretary for Planning and Evaluation) This issue paper describes the ways that Medicaid is being used now and might be used in the future under provisions of the Affordable Care Act of 2010 to serve chronically homeless people.

Housing Assistance for Youth Who Have Aged Out of Foster Care: The Role of the Chafee Foster Care Independence Program Each year the Chafee Foster Care Independence Program provides $140 million for independent living services to assist youth as they age out of foster care and enter adulthood. Under this formula grant program, states are provided allocations and allowed to use up to 30 percent of program funds for room and board for youth ages 18 to 21 who have left care. This report describes how states are using these funds to provide housing assistance to these vulnerable youth and explores how the assistance provided through this program fits in with other sources of housing assistance available in the states examined.

Medicaid and Permanent Supportive Housing for Chronically Homeless Individuals: Literature Synthesis and Environmental Scan This report reflects existing published and unpublished literature on permanent supportive housing (PSH) for people who are chronically homeless. It has a particular focus on the role that Medicaid currently plays in covering the costs of the supportive services that help people keep their housing and improve their health and quality of life. In addition to written material, this document incorporates the knowledge of housing and service configurations and ways that providers have been able to cover the cost of supportive services, garnered over our many years in the field.

Human Services and Housing Supports to Address Family Homelessness: Promising Practices in the Field  (Assistant Secretary for Planning and Evaluation) This ASPE Research Brief explores local programs for linking human services and housing supports to prevent and end family homelessness. The Research Brief is based on interviews with stakeholders in 14 communities nationwide, highlighting key practices that facilitated the implementation and ongoing sustainability of the programs. The Research Brief was prepared by Abt Associates under contract with the Office of the Assistant Secretary for Planning and Evaluation.

Homeless Children Roundtable, Conference   (Assistant Secretary for Planning and Evaluation) The purpose of the Roundtable (May 2010) was to understand the impact of homelessness on children, identify the resources currently available to address the needs of homeless children, and discuss opportunities for coordination. While other meetings have focused on the adults in homeless families, the Roundtable focused specifically on the children in families that are experiencing homelessness. A diverse group of policy experts, researchers, practitioners, and federal agency staff were invited.

Homeless Children: Discussion Synthesis   (Assistant Secretary for Planning and Evaluation) This document synthesizes the discussion from the Roundtable on Homeless Children. The background paper from this meeting is also available and provides an update on the research, policy, laws, and funding for programs and services for children who are homeless in the United States.

Homeless Children: Update on Research, Policy, Programs, and Opportunities  (Assistant Secretary for Planning and Evaluation) Despite the knowledge that homeless children face poor outcomes, research has largely focused on the parent(s) in a homeless family, perhaps because these children are still part of a family unit. The children themselves, however, have different and separate needs from their parent(s). Given the impact of the current recession, it is critical to understand the impact of homelessness on our youngest population, and to ensure that resources are mobilized to guarantee that these children's needs are met quickly and thoroughly. This paper provides an update on the research, policy, laws, and funding for programs and services for children who are homeless in the United States. Education, health, and mental health for homeless children are examined.

Findings from a Study of the SSI/SSDI Outreach, Access, and Recovery (SOAR)  Initiative   (Assistant Secretary for Planning and Evaluation) The Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) programs provide critical income support for those who meet eligibility requirements. The SSI/SSDI Outreach, Access, and Recovery (SOAR) initiative aims to improve access to SSI/SSDI benefits for individuals who are homeless through a multi-pronged strategy designed to mitigate the challenges this population faces when navigating the SSI/SSDI application process. To determine how and the extent to which SOAR is achieving its goals, ASPE conducted an evaluation of SOAR. The goals of the evaluation were to (1) provide a comprehensive description of SOAR processes, (2) examine the outputs and some of the short- and long-term outcomes that may be associated with these processes, (3) assess the factors that appear to be associated with successful implementation of the initiative, and (4) describe ways in which the initiative might be improved at either the state or federal level. This report summarizes the findings from the evaluation.

Homelessness Data in HHS Mainstream Programs  (Assistant Secretary for Planning and Evaluation) This study explores the extent to which states collect data on housing status and homelessness from applicants for the two largest HHS mainstream programs that may serve individuals or families experiencing homelessness:  Medicaid and Temporary Assistance for Needy Families (TANF). Interviews were conducted with TANF and Medicaid directors in all 50 states and the District of Columbia to learn about state practices related to the collection of housing status and homelessness data from program applicants. The study also includes a review of data-collection practices in nine other HHS mainstream programs. The Assistant Secretary for Planning and Evaluation (ASPE) and the Health Resources and Services Administration (HRSA) jointly funded this project. The study yielded three publications:

• Homelessness Data in Health and Human Services Mainstream Programs , Final Report, Winter 2009.
• Housing Status Assessment Guide for State TANF and Medicaid Programs , Winter 2009.
• Potential Analyses with Homelessness Data: Ideas for Policymakers and Researchers , Winter 2009.

Study of HHS Programs Serving Human Trafficking Victims This project developed information on how HHS programs are currently addressing the needs of victims of human trafficking, including domestic victims (i.e., citizens and legal permanent residents), with a priority focus on domestic youth. The project provides in-depth and timely information to help HHS design and implement effective programs and services that help trafficking victims overcome the trauma and injuries they have suffered, to regain their dignity, and become self-sufficient. Components to the study include a comprehensive review of relevant literature, studies or data (published or unpublished) related to providing services to victims of human trafficking (including domestic victims); nine site visits to geographic areas (e.g., counties) containing at least one HHS- or federally-funded program currently assisting victims of human trafficking; at least three brief reports highlighting interesting, innovative, and/or effective experiences, knowledge, or information resulting from one or more of the site visits; and a final report providing a synthesis of all information obtained under the study.

The Mental Health of Vulnerable Youth and their Transition to Adulthood: Examining the Role of the Child Welfare, Juvenile Justice, and Runaway/Homeless Systems This project focused on the mental health of vulnerable youth who have been in contact with service systems, including child welfare, juvenile justice, and run-away and homeless programs. Data for this project come from the  National Longitudinal Study of Adolescent Health  (Add Health). The Add Health is a nationally representative study that was designed to examine the causes of health-related behaviors of adolescents and their outcomes in young adulthood. The analytic sample for this current study was limited to participants who completed an interview at Waves 1 and 3 and who have a valid population weight for these Waves.

Final Report for the Independent Evaluation of the Substance Abuse Prevention and Treatment Block Grant Program (Substance Abuse and Mental Health Services Administration) The independent evaluation of the Substance Abuse Prevention and Treatment Block Grant (SABG) was conducted to assess the extent to which the SABG Program is effective, functioning as intended, and achieving desired outcomes. Key Finding 1 indicates the SABG program demonstrated a positive outcome in the stable housing domain of the client-level National Outcome Measures (NOMs) between admission to and discharge from a treatment episode.

• Executive Summary (PDF | 209 KB)
• Highlights of Key Findings (PDF | 1.4 MB)
• Detailed Key Findings (PDF | 2.5 MB)
• Final Report (PDF | 1.1 MB)

Characteristics and Dynamics of Homeless Families with Children  (Assistant Secretary for Planning and Evaluation) This report investigates the availability of data with which to construct a typology of homeless families with the goal of identifying key knowledge gaps regarding homeless families and to consider whether these gaps may most efficiently be filled through secondary analysis of existing data, adding questions or a module to planned surveys that include low-income populations, or whether additional primary data collection would be needed. Ultimately, it is intended that an improved understanding of the characteristics of homeless families with children will guide the development of appropriate service responses to such families and provide an empirical foundation for the design of homelessness prevention and intervention approaches. The project consisted of three phases: assessing the availability of already existing data that could be mined through secondary data analysis; proposing a set of questions to modify existing and ongoing surveys that would allow for the key research questions related to homeless families to be answered, and conceptualizing various primary data collections that would specifically collect the kind of data required to develop a typology of homeless families.

Evaluation of the Collaborative Initiative to Help End Chronic Homelessness  (Assistant Secretary for Planning and Evaluation) A cornerstone effort of the Administration goal to end chronic homelessness was the development of the  Collaborative Initiative to Help End Chronic Homelessness  (CICH), an innovative demonstration project coordinated by the U.S. Interagency Council on Homelessness, jointly funded by the Departments of Housing and Urban Development, Health and Human Services (HHS: SAMHSA and HRSA), and Veterans Affairs.

Summary of CICH Interim Reports The summary reviews the background of the study, the methods, client outcomes, and system outcomes.

Preliminary Client Outcomes Report , February 2007  This report presents data on screening, enrollment, client characteristics across sites, service use over time, and outcomes during the first 12 months of CICH participation. Data are also presented on a comparison group that received some lesser combination of housing and services than the CICH clients.

An Evaluation of an Initiative to Improve Coordination and Service Delivery of Homeless Service Networks , February 2007  This report examines the service system of the CICH during the first 24 months of the program including the types of housing and service models that were available for the target population and the nature of the interaction between agencies in the CICH.

Is System Integration Associated with Client Outcomes? , June 2007 This report merges network data reflecting collaboration, trust and use of evidence-based practices at the time clients enrolled in the CICH with 12-month client outcome data to examine the association of interagency relationships at the start of the program and client outcome during the first year of program participation.

Computer Retrieval of Information on Scientific Projects   (National Institutes of Health) The National Institutes of Health (NIH) supports a wide range of studies involving homeless populations because of associations between homelessness and many adverse health conditions. Research projects funded via an NIH grant are traditionally published in scientific journals. To access a full list of research relevant to homelessness currently being supported by NIH and other Public Health Agencies, follow the link to search Computer Retrieval of Information on Scientific Projects (CRISP). CRISP is a searchable database of federally funded biomedical research projects conducted at universities, hospitals, and other research institutions. The database, maintained by the Office of Extramural Research at the National Institutes of Health, includes projects funded by the National Institutes of Health, Substance Abuse and Mental Health Services Administration, Health Resources and Services Administration, Food and Drug Administration, Centers for Disease Control and Prevention, Agency for Health Care Research and Quality, and Office of Assistant Secretary of Health.

Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research   (Department of Health and Human Services and Department of Housing and Urban Development) The National Symposium on Homelessness Research, co-funded by the Department of Health and Human Services (both Assistant Secretary for Planning and Evaluation and Substance Abuse Mental Health Services Administration) and the Department of Housing and Urban Development in FY 2005, sponsored the development of twelve research papers in an effort to capture the current state of the research related to homelessness. The Symposium event itself, which was held over two days in March of 2007, brought together 200 researchers, policy makers, government officials, service providers, and consumers from across the country to discuss the research papers and directions for future research related to homelessness. This Symposium was a follow-on event to the first National Symposium on Homelessness Research, which took place in 1998 and was also sponsored by Department of Health and Human Services and the Department of Housing and Urban Development. This volume presents the twelve papers developed and presented at the 2007 Symposium.

Promising Strategies to End Youth Homelessness  (Administration for Children and Families)

Provides an overview of youth homelessness, as well as a set of preventive strategies that show promise in the effort to end homelessness. This report was created by the Administration for Children and Families, in consultation with the U.S. Interagency Council on Homelessness.

Strategic Action Plan on Homelessness   (Department of Health and Human Services)

Report details Departmental strategies to prevent homelessness; ensures the provision of services to eligible individuals and families; empower states and community partners to improve their response to homelessness, and track Departmental progress in reaching these goals.

Condensed Version  of the Medicaid Primer on How to Use Medicaid to Assist Persons Who are Homeless to Access Medical, Behavioral Health and Support Services (Centers for Medicare and Medicaid Services) Primer to help to connect people who are homeless with critical Medicaid benefits

An Evaluation of the Respite Pilot Initiative  (Health Resources and Services Administration) In May 2000, Health Resources Services Administration (HRSA) funded ten Health Care for the Homeless grantees, for up to five years, to enhance their medical respite services for homeless persons. HRSA also supported a prospective evaluation to document the differing models of respite care delivery being used and assess the effect of those respite services on the health of homeless persons. 

Evaluability Assessment of Discharge Planning and the Prevention of Homelessness: Final Report   (Assistant Secretary for Planning and Evaluation) The purpose of this study was to conduct an evaluability assessment of discharge planning in institutional and custodial settings, with a specific focus on whether discharge planning is a strategy that can prevent homelessness. 

Using Medicaid to Support Working Age Adults with Serious Mental Illness in the Community: A Handbook  (Assistant Secretary for Planning and Evaluation) The purpose of this primer is to describe the Medicaid program in the delivery of services to adults with serious mental illnesses; specifically, the primer explains how existing Medicaid options and waivers are used by states to finance a broad range of community services and supports for adults with serious mental illnesses, and to demonstrate what aspects of state-of-the-art community services and supports for this population are funded by Medicaid.

The Implementation of Maternity Group Home Programs: Serving Pregnant and Parenting Teens in a Residential Setting Given the considerable interest in maternity group homes and the roles they can play in assisting pregnant and parenting teens’ transition to independence, it is important to fill some of the gaps in the existing research. For this reason, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at the U.S. Department of Health and Human Services is interested in learning more about maternity group home programs and in assessing the feasibility of conducting a rigorous evaluation to measure the effectiveness of such programs. To this end, ASPE contracted with Mathematica Policy Research, Inc. to conduct a study of how these programs operate and to explore options for studying them further. This report aims to document the implementation of maternity group home programs.

Improving Medicaid Access for People Experiencing Chronic Homelessness: State Examples (Centers for Medicare & Medicaid Services) This technical assistance report is designed to highlight several state initiatives that increase Medicaid access for people who are chronically homeless.

Maternity Group Homes Classification and Literature Review This document provides an overview of past research and develops a preliminary classification framework for maternity group homes. The report classifies maternity group homes according to population served, degree of structure and supervision provided, and level of support services offered. The report also reviews research related to maternity group homes by categorizing existing studies into four groups: those that describe the characteristics of maternity group homes, but do not report data on outcomes; those that collect some data, but without any context for comparison; those that compare outcomes of different groups or at different points in time; and those that look at implementation of maternity group homes. Included in the review of research are resident characteristics, experiences during residence, outcomes after leaving maternity group homes, limitations of existing studies, and recommendations for future research.

Achieving the Promise: Transforming Mental Health Care in America  (President's New Freedom Commission on Mental Health) In 2002, the President announced the creation of the New Freedom Commission on Mental Health and charged the Commission to study the mental health service delivery system, and to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbance to live, work, learn, and participate fully in their communities.  Achieving the Promise  is the final report of the New Freedom Commission.

Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS Pocket Guidebook (Health Resources and Services Administration) This condensed pocket guidebook on adapting clinical guidelines for homeless clients with HIV/AIDS was a project of the HIV/AIDS Bureau Homelessness and Housing Workgroup in revising the original manual,  Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS (2003) , developed by the Health Care for the Homeless Clinicians’ Network. 

Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS  (Health Resources and Services Administration) A clinical guidebook written by clinicians with extensive experience caring for individuals who are homeless and who routinely adapt their medical practice to foster better outcomes for these patients. 

Core Performance Indicators for Homeless-Serving Programs Administered by the U.S. Department of Health and Human Services  (Assistant Secretary for Planning and Evaluation) This report explores the feasibility of developing a core set of performance measures across four Health and Human Services (HHS) programs that focus on service delivery to homeless persons. The report also explores the extent to which mainstream service-delivery programs supported by HHS, i.e., those not specifically targeted to homelessness, could generate performance measures on the extent to which homeless persons are served and to what effect. 

Ending Chronic Homelessness: Strategies for Action   (Department of Health and Human Services) This document was developed in 2003 by the Health and Human Services Secretary’s Work Group on Ending Chronic Homelessness to outline a series of goal and strategies that would align the Department’s effort towards the goal of ending chronic homelessness.

The 1996 National Survey of Homeless Assistance Providers and Clients: A Comparison of Faith-Based and Secular Non-Profit Programs  (Assistant Secretary for Planning and Evaluation) This study examines data from National Survey of Homeless Assistance Providers and Clients to determine more thoroughly the role that faith-based programs play in the larger context of homeless assistance. The study has an explicit focus on comparing homeless assistance programs administered by faith-based versus secular non-profit service agencies. It provides a basic but comprehensive picture of the numbers and characteristics of the two types of homeless assistance programs.

Practical Lessons:  The 1998 National Symposium on Homelessness and Research   (Department of Health and Human Services and the Department of Housing and Urban Development) This symposium was jointly sponsored with HUD and provides 13 papers that summarize more than a decade of research on homelessness.

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Homeless Youth in the United States: Recent Research Findings and Intervention Approaches

Report Acceptance Date: September 2007 (33 pages)

Posted Date: December 31, 2008

Paul A. Toro, PhD, Wayne State University, Detroit, MI Amy Dworsky, PhD, University of Chicago, Chicago, IL Patrick J. Fowler, MA, Wayne State University, Detroit, MI Disclaimer: The paper presents the views and opinions of the respective author(s) and does not necessarily represent the views, positions, and policies of the federal government.

In this paper, the authors cite research indicating that youth may be the single age group most at risk of becoming homeless, yet comparatively little research has been done in the past decade on this vulnerable population. Some important progress has been made, including longitudinal studies on youth “aging out” of foster care. After reviewing the characteristics of homeless youth, the authors review recent research findings on the homeless youth population and interventions developed to address their housing and service needs. These include interventions directed at youth themselves (education, employment, social skills training) as well as family-focused strategies. The authors conclude with future directions for both research and practice.

A Literature Review of Homelessness In The United States

Homelessness in the United States 

The homelessness crisis is a highly prevalent issue that the entirety of our country is facing. For reference, in an article written by Emo Zhao from the International Journal of Sustainable Development & World Ecology, she expresses that in the US between the years of “2007 and 2019, there were over half a million homeless people per night living on the streets” (Zhao). In a research article written by Deborah Finfgeld-Connett it was indicated that per year roughly “3.5 million Americans experience homelessness” (Connett). Across the board, rhetoric expresses that the homelessness crisis is multifaceted in nature, as a number of different factors have caused the problem to occur. In tandem with the catalyzation of the problem, varying approaches have been taken to address homelessness. In order to research the topic of homelessness further, this literature review explores the common attributes that play a role within homelessness. This review will focus on where homelessness stems from: unaffordable housing, the mental health crisis, the foster care system, as well the notion of unstable home environments. 

Unaffordable Housing

Across the United States, the cost of living is not equitable given the wages that people are paid; the surge in housing prices has pushed not only individuals but families into homelessness. In turn, the lack of affordable housing has caused those who are already homeless to have an increasingly difficult time finding and sustaining housing (Lind). In an article written by Diana Lind from the Architectural Record, she explains that the lack of affordable housing has pushed the inequality gap in our society to an increasingly far extent (Lind). A research paper in the Journal of Social Distress and Homelessness written by Diane Joy Irish & Stephen W. Stoeffler supports this claim by arguing that the inequality gap can be evidenced through the “19 million families” who are “cost burdened” in the US as a result of spending “50% or more of their income” on their place of residence. Irish and Stephen go on to dictate that, in spending half of their earnings on housing, families are having a challenging time affording other necessities leaving them financially insecure. Emo Zhao explains that the cycle of stress pertaining to housing insecurity is very grueling. In fact, living in poor-quality environments has been evidenced to lower one’s overall well-being, both mentally and physically. Zhao goes on to write that the impacts on individuals’ health creates problems that last for an extended period of time, and given the number of homeless individuals this is a major concern for the state of our public health in the United States (Zhao). In the research paper written by Irish and Stoeffler from the Journal of Social Distress and Homelessness, they detail that states are failing to recognize that as the cost of housing continues to rise, the wages people are paid needs to rise as well. Minimum wage jobs not paying nearly enough to sustain the cost of living in states in the United States. Because of  a failure to recognize this gap, those who are homeless are left stuck, and those who are struggling to pay for living, are met with insecurity of what their future will look like.  As a result of the non-livable wages individuals and families experience housing insecurity (Irish and Stoefller). 

Mental Health Crisis

As a result of the level of instability and a lack of access to resources, the mental health crisis among the homeless population in the United States is and has been exacerbated. Thus, when a person is homeless they are more susceptible to becoming mentally ill. Debroah K. Padgett wrote an article in the BJPsych Bulletin that was later published by Cambridge University Press in which she demonstrated that when compared with those who had stable housing, homeless individuals have disproportionately suffered from mental health struggles such as depression, suicidal ideation, misuse of substances, and trauma. Padgett explained that the exposure to the “natural elements” is a grueling experience and can be linked back to a lack of mental wellness among the homeless population (Padgett). In the study mentioned previously, done by Ema Zhao with International Journal of Sustainable Development & World Ecology, the research that the study conducted aimed at assessing the “key factors pertaining to the persistence of homelessness”. The study concluded that mental illness can be worsened and or onset when in the presence of homelessness. Zhao’s findings also added the notion of homelessness being difficult to “escape” when a person is struggling with mental illnesses (Zhao). These sources reckon that the mental health crisis disproportionately impacts the homeless community as a result of their living conditions.

Foster Care System and Growing Up in Unstable Home Environments

The foster care system and growing up in unstable home environments are both precursors for homelessness within the United States. Within the foster care system, there is a lack of resources available for young people when they “age out” of the system. With a lack of resources, youth are not given the level of support needed to successfully engage with society independently. Not only is homelessness impacting teens aging out of foster care but this problem has destructive effects on a larger population of young people. Those who have grown up in unstable home environments are at a higher risk of being homeless as well. The Gale Opposing Viewpoints Online Collection wrote that, “4.2 million US adolescents, teens, and young adults experience at least one period of homelessness each year” (Gale). They go on to write that, young people in foster care, are provided with care up until they are an adult however, once they reach a legal age they are often left to fend for themselves. An article written by Shah MF, Liu Q, Mark Eddy J, Barkan S, Marshall D, Mancuso D, Lucenko B, Huber Ain, the American Journal of Community Psychology  dictates that there between “11% and 37% of youth aging out experience homelessness one or more times in the years following their transition”. Beyond that, “an additional 25–50%” of youth “experience housing instability”(Shah MF). The article by the American Journal of Community Psychology goes on to argue that as a result of not being equipped with a support system that most of their peers have, these young people are made to navigate challenging situations on their own (Shah MF, Liu Q, Mark Eddy J, Barkan S, Marshall D, Mancuso D, Lucenko B, Huber). Another journal which was written by JoAnn S. Lee, Gilbert Gimm, Maya Mohindroo, and Louise Lever from the Child and Adolescent Social Work Journal wrote that “the transition to adulthood is especially difficult for youth who age out of the foster care system because they lack the normative social and financial support of family” (Lee). Thus, all of these sources express that as a result of there being limited resources, the foster care system does not effectively provide sufficient tools or support for these young people to live successfully on their own, making homelessness a higher risk for this population of young people. Among teens who are not in foster care, the article written by the Gale Opposing Viewpoints Online Collection expresses that the nature of teen homelessness results from “family conflict, exposure to abuse or trauma, substance abuse, mental health problems, and low levels of academic achievement”. They go on to write that adolescents who identify within communities of color, particularly black, hispanic, and LGBTQ+ youth are at an additional space of vulnerability. Once the teens are homeless, they are in jeopardy of being exposed to “low levels of academic achievement, delinquency and contact with the criminal justice system, substance abuse, mental health concerns, and sexual exploitation,” ( Gale Opposing Viewpoints Online Collection ). This puts these teens in an agonizing cycle. Homeless youth, both those who have aged out of foster care and those who end up homeless without ever having been in the system, are a population that needs more attention and support because of the risk levels that they are exposed to.

Homelessness in the United States is a growing issue that impacts millions of people across the country. With the prominence of unaffordable housing, a society that struggles from mental health issues, a broken foster care system, and a high rate of teens who are at risk because of their unstable home environment, it is evident that the homelessness crisis is out of hand. The concerning aspect of this review is that it only touches upon the tip of the iceberg.

Works Cited

Finfgeld-Connett, Deborah. “Becoming Homeless, Being Homeless, and Resolving 

Homelessness among Women.” Issues in Mental Health Nursing , vol. 31, no. 7, 2010, pp. 461–469., https://doi.org/10.3109/01612840903586404.

Irish, Diane Joy, and Stephen W. Stoeffler. “The Structural Nature of Family Homelessness: A 

Critical Analysis of the Intersection of Unaffordable Housing, Housing Insecurity, Non-Livable Wages, and Eviction.” Journal of Social Distress and Homelessness , 2023, pp. 1–10., https://doi.org/10.1080/10530789.2023.2187521.

Lee, JoAnn S., et al. “Assessing Homelessness and Incarceration among Youth Aging out of 

Foster Care, by Type of Disability.” Child and Adolescent Social Work Journal , 2022, https://doi.org/10.1007/s10560-022-00817-9 .

LIND, DIANA. “Living in the U.S.: At What Cost? Rising Housing Prices Are Outpacing Wage 

Increases Nationwide, Threatening a Living Standard That Once Seemed an Inalienable Right.” Architectural Record , vol. 206, no. 10, Oct. 2018, pp. 80–83. EBSCOhost , search.ebscohost.com/login.aspx?direct=true&AuthType=shib&db=a9h&AN=132093266&authtype=sso&custid=s3818721&site=ehost-live&scope=site.

Padgett, Deborah K. “Homelessness, Housing Instability and Mental Health: Making The 

Connections.” BJPsych Bulletin , vol. 44, no. 5, 2020, pp. 197–201., https://doi.org/10.1192/bjb.2020.49.

Shah, Melissa Ford, et al. “Predicting Homelessness among Emerging Adults Aging out of 

Foster Care.” American Journal of Community Psychology , vol. 60, no. 1-2, 2016, pp. 33–43., https://doi.org/10.1002/ajcp.12098 .

“Teen Homelessness.” Gale Opposing Viewpoints Online Collection , Gale, 2019. Gale In 

Context: Opposing Viewpoints , link.gale.com/apps/doc/PC3010999079/OVIC?u=usfca_gleeson&sid=bookmark-OVIC&xid=e2f048c5. Accessed 30 Mar. 2023.

Zhao, Emo. “The Key Factors Contributing to the Persistence of Homelessness.” International 

Journal of Sustainable Development & World Ecology , vol. 30, no. 1, 2022, pp. 1–5., https://doi.org/10.1080/13504509.2022.2120109.

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With Homelessness on the Rise, the Supreme Court Weighs Bans on Sleeping Outdoors

The Supreme Court is wrestling with major questions about the growing issue of homelessness as it considers whether cities can ban people from sleeping outside when shelter space is lacking

J. Scott Applewhite

Activists demonstrate at the Supreme Court as the justices consider a challenge to rulings that found punishing people for sleeping outside when shelter space is lacking amounts to unconstitutional cruel and unusual punishment, on Capitol Hill in Washington, Monday, April 22, 2024. (AP Photo/J. Scott Applewhite)

WASHINGTON (AP) — The Supreme Court wrestled with major questions about the growing issue of homelessness on Monday as it considered whether cities can punish people for sleeping outside when shelter space is lacking.

It's the most significant case before the high court in decades on the issue, and comes as record numbers of people are without a permanent place to live in the United States.

The case started in the rural Oregon town of Grants Pass , which began fining people $295 for sleeping outside as the cost of housing escalated and tents sprung up in the city’s public parks. The San Francisco-based U.S. 9th Circuit Court of Appeals struck down the law under its holding that banning camping in places without enough shelter beds amounts to cruel and unusual punishment.

The justices appeared to be leaning toward a narrow ruling in the case after hearing arguments that showed the stark terms of the debate over homelessness in Western states like California , which is home to one-third of the country's homeless population.

Sleeping is a biological necessity, and people may be forced to do it outside if they can't get housing or there's no space in shelters, Justice Sonia Sotomayor said.

“Where do we put them if every city, every village, every town lacks compassion and passes a law identical to this? Where are they supposed to sleep? Are they supposed to kill themselves, not sleeping?" she said.

Photos You Should See - April 2024

Solving homelessness is a complicated issue, said Justice Brett Kavanaugh. He questioned whether ticketing people for camping helps if there aren't enough shelter beds to hold everyone, but also raised concerns about federal courts “micromanaging” policy.

Other conservative justices asked how far Eighth Amendment legal protections should extend as cities struggle with managing homeless encampments that can be dangerous and unsanitary.

“How about if there are no public bathroom facilities, do people have an Eighth Amendment right to defecate and urinate outdoors?” said Justice Neil Gorsuch.

Other public-health laws cover that situation, Justice Department attorney Edwin Kneedler said. He argued people shouldn’t be punished just for sleeping outside, but said the ruling striking down the Grants Pass law should be tossed out because the court didn't do enough to determine if people are “involuntarily homeless.”

Gorsuch and other justices also raised the possibility that other aspects of state or federal law could help sort through the issue, potentially without setting sweeping new legal precedent.

The question is an urgent one in the West, where a cross-section of Democratic and Republican officials contend that the 9th Circuit's rulings on camping bans make it difficult for them to manage encampments. The appeals court has jurisdiction over nine states in the West.

Advocacy groups, on the other hand, argued that allowing cities to punish people who need a place to sleep will criminalize homelessness and ultimately make the crisis worse as the cost of housing increases.

Hundreds of demonstrators gathered outside the Supreme Court Monday morning to advocate for more affordable housing, holding silver thermal blankets and signs like “housing not handcuffs.”

Homelessness in the United States grew a dramatic 12% last year to its highest reported level, as soaring rents and a decline in coronavirus pandemic assistance combined to put housing out of reach for more people.

More than 650,000 people are estimated to be homeless, the most since the country began using the yearly point-in-time survey in 2007. Nearly half of them sleep outside. Older adults, LGBTQ+ people and people of color are disproportionately affected, advocates said.

In Oregon, a lack of mental health and addiction resources has also helped fuel the crisis. The state has some of the highest rates of homelessness and drug addiction in the nation, and ranks near the bottom in access to treatment, federal data shows.

The court is expected to decide the case by the end of June.

Rush reported from Portland, Oregon.

Copyright 2024 The  Associated Press . All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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Housing interventions for emerging adults experiencing homelessness: A scoping review

Sara semborski.

1 University of Southern California

Brian Redline

Danielle madden, theresa granger, benjamin henwood.

Sara Semborski: Conceptualization; Methodology; Formal analysis; Visualization; Writing – Review & Editing

Brian Redline: Conceptualization; Methodology; Software; Formal analysis; Visualization; Writing – Review & Editing; Project administration

Danielle Madden: Methodology; Formal analysis; Data curation; Writing – Review & Editing

Theresa Granger: Conceptualization; Methodology; Formal analysis; Validation; Supervision; Writing – Review & Editing

Benjamin Henwood: Conceptualization; Methodology; Formal analysis; Supervision; Funding acquisition; Writing – Review & Editing

Associated Data

Introduction..

This review aims to identify and synthesize literature focused on housing interventions for young adults experiencing homelessness.

Following a five-stage approach to scoping reviews, a computerized search was conducted between February 4–8, 2019 to include peer-reviewed articles from a total of eight electronic databases: PsychINFO, Google Scholar, PubMed, Web of Science, Social Work Abstracts, Cochrane, Clinicaltrials.gov , and CINAHL. The search was limited to include literature published between January 1, 1987 and December 31, 2018. Search parameters included three domains: homelessness, housing intervention, and age.

Of the initial 7,344 sources identified, 29 articles met the search criteria and were included in the final sample. Housing models discussed in the reviewed literature include Permanent Supportive Housing, Transitional and Independent Housing and Living Programs, the Foyer model, Housing First, and general Supportive Housing. Housing models were discussed in the context of outcome domains including quality of life, education, employment, housing tenure, cost of intervention, systems and service use, HIV, and social network and relationships.

Discussion.

Housing interventions for young adults experiencing homelessness remains a relatively new intervention to combat homelessness among younger demographics. While the evidence base continues to grow, there remains a need for quality research to generate empirical evidence in this area, though studies included in this review showed promise for the development of best housing practices with this population.

1. Introduction

In 2010, the United States government identified immediate access to housing accompanied by supportive services, also known as permanent supportive housing (PSH), as the “clear solution” to homelessness for adults who have a disabling condition and have experienced longer term homelessness (USICH, 2010). This was based on nearly two decades of research that included studies of PSH using either a randomized control trial or quasi-experimental design that showed high housing retention and reduced cost for this population of adults considered to be “chronically homeless” ( Padgett et al., 2016 ). While some studies of PSH have included young adults aged 18–25 in their sample ( Kozloff, Adair, et al., 2016 ), the chronically homeless population (i.e., those with lasting or recurring episodes of homelessness) tends to be older with an average age in the United States approaching 60 years old ( Culhane et al., 2013 ). Currently, there is no clear consensus on what type of housing intervention works best for young adults ( Semborski et al., 2020 ; Tabol et al., 2010 ) who are in a unique developmental stage also known as “emerging” adulthood that is characterized by shifting roles and identities ( Arnett, 2000 ).

Recent estimates suggest that as many as one-in-ten young adults aged 18–25 experience some form of homelessness over the course of one year ( Morton et al., 2018 ). In addition to the immediate need for shelter, housing unstable young adults face multiple challenges that make them particularly vulnerable. Evidence shows that those who experience homelessness during emerging adulthood often face a number of physical and mental health problems ( Hodgson et al., 2013 ; Medlow et al., 2014 ; Perlman et al., 2014 ), exacerbated by violence and victimization ( Heerde et al., 2014 ) that often result in increased substance use ( Greene et al., 1997 ; Greene & Ringwalt, 1998 ; Nyamathi et al., 2010 ; Thompson et al., 2015 ), unplanned and early pregnancy ( Greene & Ringwalt, 1998 ; Thrane & Chen, 2012 ), and early death ( Auerswald et al., 2016 ). Beyond the adversity associated with homelessness, emerging adulthood is a critical period that often can set a trajectory for the remainder of the life course ( Franke & Anda, 2013 ).

Age appropriate, evidence-based housing interventions appear critical, for homeless young adults who represent a heterogenous group ( Semborski et al., 2020 ). Some housing models being implemented for young adults include: PSH, or time-unlimited housing paired with comprehensive wrap-around services; Transitional Living Programs – sometimes referred to as Independent Living Programs or Foyers ( Levin et al., 2015 ). Transitional models are time-limited, may or may not come with comprehensive wrap-around services, and typically have a large focus on education, training, and employment ( Gaetz, 2014 ). Finally, Rapid Rehousing, which typically provides time-limited housing support in community-based settings with fewer in-house supportive services ( Di Felice, 2014 ). In addition to differences in the structure of these models, some researchers have emphasized the importance of an underlying program philosophy such as whether young adults should be required to seek treatment (e.g., for mental health and/or substance abuse) or participate in employment in exchange for housing, or, on the other hand, should program participants have choice in the types of activities they engage in without requirements tied to housing ( Gaetz, 2014 ). The idea that adequate housing ought to be available to all, and not just those who satisfy “housing-ready” conditions, such as drug use treatment, is known as Housing First ( Padgett et al., 2016 ). Further philosophies that underlie work with youth, adolescents, and young adults include Positive Youth Development, a developmentally appropriate practice approach that focuses on identifying and strengthening protective factors in both the individual lives of young people and their broader environment ( Waid & Uhrich, 2020 ).

Given the range of practice approaches with young people ( Waid & Uhrich, 2020 ), the lack of consensus for a “clear solution” to young adult homelessness, and more recent emphasis by the U.S. federal government to expand housing programs to meet the diverse needs of unstably housed young adults ( USICH, 2017 ; USICH, 2012 ), this scoping review aims to identify and synthesize literature focused on housing interventions for young adults. The questions to be addressed were defined as follows:

• What types of housing programs for young adults experiencing homelessness have been evaluated?
• What domains have studies of housing programs for young adults experiencing homelessness reported on (e.g., housing outcomes, health outcomes, employment, etc.)?
• What outcomes or common experiences are reported in housing programs for young adults experiencing homelessness?

2.1. The scoping review

A scoping review seeks to map the key concepts underpinning an area of research, highlighting the main sources and types of evidence available ( Arksey & O’Malley, 2005 ; Mays et al., 2001 ). This type of review is appropriate when there is complexity such that the research area has not been clearly defined or comprehensively reviewed ( Mays et al., 2001 ). Following the five-stage framework put forth by Arksey and O’Malley (2005) that has been further outlined by the Joanna Briggs Institute (JBI) ( Peters et al., 2019 ), we developed an a priori method to search and identify literature relevant to our research questions.

2.2. Identifying relevant studies

A computerized search was conducted between February 4–8, 2019 to include peer-reviewed articles from a total of eight electronic databases: PsychINFO, Google Scholar, PubMed, Web of Science, Social Work Abstracts, Cochrane, Clinicaltrials.gov , and CINAHL. The search was limited to include literature published between January 1, 1987 and December 31, 2018. Search parameters included three domains based on study aims: homelessness, housing intervention, and age. Search terms across these domains were developed out of an initial literature review and reviewed by several researchers and providers in the field. See Table 1 for a complete list of search terms. A health science research librarian familiar with scoping reviews conducted the initial search.

Specific search terms used.

2.3. Study selection

In total, 7,344, sources were cataloged including articles, book chapters, reports, dissertations, and abstracts. After removing duplicated items, a total of 5,044 records were retrieved. All titles and abstracts generated by the search were reviewed in adherence to the inclusion/exclusion criteria set forth by the authors, shown in Table 2 . Each record was screened for appropriate population and intervention by two independent reviewers to find consensus. Sources were marked ‘include’, ‘exclude’, or ‘uncertain.’ Any discrepancies were discussed as a review team. At the completion of this screening process, articles were imported for further screening into Covidence, a web-based software platform that supports the production of systematic reviews. Once in Covidence, titles and abstracts were screened a third time and 17 additional records were deemed irrelevant. The remaining 166 full texts were assessed for eligibility by two independent reviewers allowing for the exclusion of an additional 137 records, leaving a total of 29 articles that met final inclusion criteria. Figure 1 displays the inclusion and exclusion assessment process of the initial sources located by the search strategy.

Scoping Review of Research on Housing Interventions for Homeless Young Adults: PRISMA Diagram

Inclusion and exclusion criteria.

2.4. Data extraction

Important information regarding each of the included articles was organized and charted in Microsoft Excel per the categories recommended by Arksey and O’Malley (2005) , adapted by the authors to best fit the subject of this scoping review. Categories used to organize the data were: study population, study aims, overview of methods, outcome measures, and main findings. Charting the data allowed for data to be organized by type of study (i.e., qualitative, descriptive or case study, non-experimental, and quasi-experimental or experimental) and then housing model.

2.5. Collating, summarizing, and reporting the results

In order to present the overall results from the included sources, the results were organized using two strategies. First, articles were organized by study design: qualitative, case study and/or descriptive, non-experimental, and quasi-experimental or experimental. Within each design type, articles were then collated by intervention (i.e., model of housing program). Findings across study design were then reported by outcome in order to distill the breadth and scope of the state of the evidence on housing programs for emerging adults.

3.1. Search results

Of the original 5,044 unique sources identified, 166 were considered eligible for inclusion. Sources at this stage were excluded (n=4,878) for the following reasons: wrong population, wrong intervention, wrong population and intervention, or non-research.

3.2. Inclusion of evidence sources by study design

The results comprised 29 papers after full-text review allowed the exclusion of 137 out of the 166 articles considered eligible for inclusion using the same exclusion reasons during the screening phase. Full details of the included 29 articles may be found in the Tables of Included Source Evidence Characteristics in Appendices 1 – 4 . The majority (n=11) were either of qualitative design (see Appendix 1 ) or could be qualified as case studies and/or descriptive in nature (n=11) (see Appendix 2 ), four were non-experimental (see Appendix 3 ), and three were quasi-experimental or experimental designs (see Appendix 4 ). Studies that employed a qualitative design recorded findings primarily focused on the experiences and impacts of housing programs, including impacts on social networks and service utilization, from the perspective of young adult residents. Among the eleven articles that were descriptive and/or utilized a case study design, results discussed housing tenure, employment, service use, and quality of the youth service setting. Non-experimental studies examined outcomes such as employment, education, housing tenure, and HIV, as well as costs and quality of service settings. Quasi-experimental studies focused on service use. Finally, the included experimental studies produced evidence on self-reported quality of life, employment, housing tenure, and overall characteristics of young adult residents. See Table 3 for a complete list of outcomes by study design that corresponds with the numbered articles listed in the Appendices .

Outcome by Study Design

Note: numbers correspond with article number listed in Appendices 1 – 4 .

3.3. Review of findings

Following data extraction, included articles were reviewed to catalogue the study aims, measures, outcomes, results, and limitations to distill necessary information to answer the research questions. First, we describe the interventions (i.e., housing program model) as described in the included articles, followed by an examination into the breadth and scope of the literature by outcome domain.

3.3.1. Review of featured housing models

A review of the housing models featured in the sources of evidence are shown in Table 4 . Across the 29 included articles, authors describe housing programs in terms of three models and/or housing philosophies: 1) Transitional Housing Programs, referred to as Transitional Living Programs (TLP), Independent Living Programs (ILP), and Foyers; 2) Supportive Housing (SH); and 3) Housing First (HF). Most articles (n=20) featured TLPs, ILPs, or Foyers. Seven papers described their model as SH, and two described their model as HF.

Housing models featured in sources of evidence

TLPs, ILPs, and Foyer Models were described as providing structured, time-limited housing of up to 24 months, but sometimes shorter. The focus of these models is to support independence across key domains of life skill development, education and employment, physical and mental health, and stable housing post-housing program. While TLPs and ILPs offer both scatter-site, community-based apartments and/or congregate-style living, Foyers were all congregate-style. Although one of the Foyers was located in New York, USA, Foyers otherwise were found to be more popular in the UK and Australia. Likewise, apart from the one Ethnographic Case Study of a TLP in Ontario, Canada, all examinations into TLPs or ILPS occurred in the United States.

Supportive Housing, on the other hand, was characterized as non-time limited, subsidized, permanent housing with wrap-around services. Coupled with housing, wrap-around services were offered by a multidisciplinary team, either through an Intensive Case Management model or a treatment team approach that offers a semi-independent structure with residential supervision and in-home counseling and support. SH, based on studies with programs located in the United States, Nova Scotia, Ontario, and British Columbia, Canada, was described by authors as housing paired with supportive services. Authors described SH as having a focus on rehabilitation and recovery for homeless or at-risk individuals with serious mental illness. SH was offered in both scatter- and congregate-site contexts. SH, at times is referred to as Permanent Supportive Housing (PSH). The three articles that examined PSH for young adults included programs that were all located in the United States.

Like SH, Housing First (HF), was described as non-time limited, pairing housing and supportive services, characterized by consumer choice and a harm reduction approach ( Tsemberis et al., 2004 ). Offering a low-barrier housing option, HF was described in the included sources as scatter-site housing paired with off-site Assertive Community Treatment (ACT) or Intensive Case Management (ICM), depending on client need. Additionally, HF may be viewed as a framework or philosophy, rather than a distinct housing model ( Gaetz, 2014 ). The two articles that focused on HF in this review came out of a study located across five Canadian Provinces: British Columbia, Manitoba, Ontario, Quebec, and New Brunswick.

3.3.2. Review of content by outcome

Housing tenure..

Table 4 discusses the specifics of each housing model and/or philosophy covered in the 29 sources, as numbered in Appendices 1 – 4 that provide an overview of all included sources. Authors suggested that transitional models (i.e., Transitional Housing Programs (TLPs), Independent Living Programs (ILPs), or Foyers) tend to be time-limited to a maximum of 24 months, with some being less; while Supportive Housing (SH) and Housing First (HF) are generally characterized as being non-time limited. Despite these characterizations, the samples included in the source materials may report on different tenures, based off their data. The three studies that reported on housing tenure were cross-sectional, relying on administrative data to provide length of housing tenure. Studies most often captured housing tenure categorically, exploring outcomes for those housed over a year, compared to those with less time in housing ( Duncan et al., 2008 ; Nolan, 2006 ; Pierce et al., 2018 ). One experimental study of a HF program operationalized housing tenure of study participants as the proportion of days housed for which residence data were available ( Kozloff, Adair, et al., 2016 ). In all four studies, the range of housing tenure of study participants was 18 months or less. These studies suggest that longer housing tenure is correlated with better outcomes among young adult residents ( Duncan et al., 2008 ; Kozloff, Adair, et al., 2016 ; Nolan, 2006 ; Pierce et al., 2018 ) and that HF, specifically, produced longer housing tenure, with a housing tenure over twice that of those housed in the treatment as usual group, with an adjusted mean difference of 34% (p<0.001) ( Kozloff, Adair, et al., 2016 ). The other two articles that address housing tenure were from transitional housing programs. Among TLP residents, those who stayed in the program for 12 months or longer were found to have achieved more desired program outcomes (i.e., education, employment, and wages [all p<0.001]) than those who were in the program for less than 12 months ( Pierce et al., 2018 ). Nolan (2006) stated reasons for discharge from TLP included the following: (listed in order from most to least) violations (17/40), program completion (13/40), voluntarily to pursue other opportunities (7/40), or without other plans (3/40). Nearly half of these exits were to a private residence where the previous TLP resident was not the primary renter (47%) ( Nolan, 2006 ). Twenty percent of participants in these studies exited to independent living and other exits were a return to the street (5%), college (5%), military (5%), or unknown situations (18%) ( Nolan, 2006 ). Another case study of homeless, single mothers aged 18–21 found high attrition as a result of inadequate interventions (15% stayed in the program < 1 month and 58% stayed < 6 months), attributed to a need for higher acuity services for their young, parenting residents beyond the case management and life skills services that was paired with their transitional housing model ( Duncan et al., 2008 ).

Quality of service setting and cost.

Two studies discussed the quality and cost of housing for homeless young adults. One assessed quality of service settings across 29 different organizations that serve homeless young adults using the Youth Program Quality Assessment. Findings suggest that higher quality programs (i.e., those with greater alignment to Positive Youth Development) were associated with engaging in work or educational training (p<0.01), less involvement in the street economy (p<0.01), settings that helped manage or avoid substance use (p=0.01), and settings that improved perceived resilience (p=0.03) ( Gwadz et al., 2017 ). Additionally, PSH was estimated by Dodd et al. (2018) to cost $6,750 less per year, per person than emergency shelter without factoring in any costs related to improved health care (e.g., increased income, decreased hospitalizations, or psychological benefits), yielding a 1.32 return on investment.

Service use.

Thirteen articles reported on service utilization and service-related needs, the majority of which focused on transitional housing models. However, and perhaps most notably, evidence from a randomized control trial focused on HF suggests that young adults that experience homelessness have unique trajectories and service needs that are distinct from adult homeless populations. Findings show that compared to adults housed through a housing first program, young adults residing in housing first were more likely to have not completed high school, have been assaulted in the past 6 months, and have a drug use disorder (all p<0.05). Additionally, of the 164 young adults in this sample, only 49% had a regular doctor, half reported unmet health care needs, and 61% has visited an emergency department in the past 6 months ( Kozloff, Stergiopoulos, et al., 2016 ). A qualitative inquiry into what young adults want from housing programs further illuminates the distinct needs of young adults compared to adults experiencing homelessness. Findings suggest that young adults desired individualized support and increased support through housing environments with peers, noting the importance of social ties as distinct from those among older, homeless adults ( Henwood, Redline, & Rice, 2018 ).

In transitional housing environments, the Family and Youth Services Bureau reported the proportion of clients that receive ten types of services. The types of services common to TLP environments include basic support (including housing) (68%), life skills training (64%), planned aftercare (66%), counseling/therapy (61%), employment (54%), education (54%), program connection (48%), recreational activities (41%), physical health care (30%), and community service learning (29%) ( Mares & Jordan, 2012 ). Successful service delivery and goal achievement in these areas has been linked to the use of outcome assessment tools and interdisciplinary case management ( Giffords et al., 2007 ), as well as programs that closely align with the tenants of Positive Youth Development, most notably the development of strong relationships between staff and young adult residents, a consumer-driven philosophy ( Leonard et al., 2017 ), and even the involvement of young adult residents in program design and development ( Bridgman, 2001 ).

Despite the many positives in the literature regarding service delivery and utilization in SH environments for young adults, there remains a fair amount of critique. An ethnographic study examined SH as a form of social control. Through qualitative inquiry, authors found consensus among young adults residing in SH regarding “feeling trapped in the margins” even after moving into housing. Five specific young adults surveyed felt they had “disappeared into supportive housing” because they were no longer “allowed to be visibly homeless on the streets” ( Fast & Cunningham, 2018 ). While these findings report that some young people feel trapped in the structures of SH, other findings suggest vast inadequacies in funding to keep pace with the growing demand of homelessness among 18–25-year-olds, suggesting a need for more SH opportunities for this population ( Dworsky, 2010 ). However, increases in available housing must be coupled with better matching of individual residents with the appropriate level of care ( Steen & MacKenzie, 2017 ). To meet immediate housing needs without proper funding, researchers recommended partnerships between organizations that can offer housing and organizations that can offer supportive services instead of comprehensive service provision by a single provider ( Dworsky, 2010 ). This finding was also supported by young adults experiencing homelessness who perceived a resource deficit. In qualitative interviews young adults brought up the idea of “personal responsibility and deservedness” when considering who should receive support if enough resources are not available for everyone, suggesting that the work they put in to secure their own housing ought to be considered when prioritizing who gets placed in SH ( Henwood, Redline, & Rice, 2018 ).

The focus of two final studies regarding service deficits center on LGBTQ-specific services within SH environments. One study surveyed 124 service agencies offering TLP for young adults regarding their services and the LGBTQ-inclusivity of those services. Fewer than half of the 124 participating agencies (43.5%) reported offering LGBTQ-specific services and information regarding these services was minimally present on the agency’s websites (20.2%) or Facebook pages (5.3%). Programs offering LGBTQ-specific services were more likely to be located on the West Coast or in the Northeast region, and more likely to offer counseling, support groups, and recreation or youth development activities ( Prock & Kennedy, 2017 ). Additional needs regarding LGBTQ-specific services were noted by Maccio and Ferguson (2016) , highlighting both immediate and long-term housing service needs for LGBTQ homeless young adults. Due to discrimination, harassment, and violence in shelter environments, many LGBTQ homeless young adults desire to remain on the street or in precarious housing. Thus, authors recommend crisis beds and SH, transitional or permanent, specifically dedicated to LGBTQ young adults. Additionally, older LGBTQ young adults experiencing homelessness (i.e., ages 21–24) were identified as particularly vulnerable because many programs are limited to youth under 21, and staff identified a need for more “life-after-housing services” (i.e., educational, employment, mental health, and social services) for this sub-population ( Maccio & Ferguson, 2016 ).

Experience and impacts of housing programs.

Fifteen articles discussed the experience and impacts of supportive housing on young adults, across all supportive housing models and philosophies discussed in this paper (i.e., TLP/ILP/Foyer, SH, HF). Through engagement in supportive services coupled with housing, tenants of TLPs have been reported exiting transitional housing with educational and employment gains, including wages ( Gwadz et al., 2017 ; Pierce et al., 2018 ; Rashid, 2004 ); money saved; and stable housing ( Rashid, 2004 ). Likewise, residents of the Foyer model, another type of transitional housing, had lower rates of incarceration ( Raithel et al., 2015 ). Results of applying transitional housing to families yield a slightly more nuanced finding. The work shows that while many families were able to effect notable positive changes in their lives during and after taking part in the housing program. For some the recovery from homelessness was extremely difficult. For even the most successful formerly homeless families-those that secured employment, housing, and other social supports-the escape from welfare dependence and poverty proved very difficult ( Fischer, 2000 ).

Further, decreased viral load and increased CD4 count was discovered among HIV positive young adults residing in SH ( Dodd et al., 2018 ). Evidence from a randomized control trial found no major demographic differences between those residing in HF and the control group, aside from the number of years of schooling, which was greater among those in housing. Evidence from this trial also found those in SH to self-report better health and lower rates of substance abuse than controls without stable housing ( Kisely et al., 2008 ), as well as improvements in overall quality of life and leisure two years post move-in ( Kozloff, Adair, et al., 2016 ).

Eight articles qualitatively explored the experience and impact of SH from the young adult perspective. Generally, young adults had been positively impacted by their participation in SH. Through the program they reported experiencing changing perspectives (attitudes and priorities) that involved letting go to move forward, regaining personal control over their life through newfound independence, learning new independent living skills and feeling pride in self-reliance ( Curry & Abrams, 2015 ). The presence of markers of ontological security (e.g., constancy, routine, control) positively affected participants’ mental health and well-being, which helped with positive identity construction. Most regarded living in PSH as “a chance to start my life” and considered the question of “What’s next?” within a normative developmental trajectory. An increase in ontological security related to residents’ social environment and participants’ ability to improve on social relationships, which supported improved mental health and sense of self ( Henwood, Redline, Semborski, et al., 2018 ). SH provided the structure for needed social support, bringing together young people who became like family and created a sense of belonging ( Holtschneider, 2016a ). Social cohesion within the SH environment often was facilitated by common experiences, such as utilization of an in-house music studio that facilitated relationships between residents, increased collaboration, and translated into improved intra- and interpersonal skills ( Kelly, 2017 ). It is clear on many occasions SH facilitated the development of necessary skills to flourish as an independent adult ( Holtschneider, 2016a ).

Conversely, despite transitioning out of homelessness into housing, young adult residents continued to describe their lives in terms of fragility and instability, according to one study. While housing in itself did not shape these young people’s sense of stability, it did influence increased feelings of health, happiness, and security ( Karabanow et al., 2016 ). Further, young adult residents discussed barriers to their progress, including difficulty balancing work and school. Public transportation was mentioned as a barrier to work or educational goals. Youth expressed wanting to move forward, beyond the housing program, but feeling unprepared to live independently and a need for ongoing support ( Curry & Abrams, 2015 ). Within the housing environment, some residents perceived that they were overly monitored by programmatic rules and regulations, and that mistakes and/or transgressions by others affect those who are abiding by the rules and regulations. Thus, tensions arose between residents who were viewed as “handling their business” and those who are viewed as “just hanging out” ( Curry & Petering, 2017 ). Some experiences of social isolation were noted ( Henwood, Redline, Semborski, et al., 2018 ), including concerns about safety housing programs where they were unfamiliar with other residents or where housed with older adults compared with feeling safer on the streets surrounded by friend groups, reinforcing the importance of peer relationships ( Ryan & Thompson, 2013 ). Finally, struggles with mental health were associated with less positive orientations toward “what’s next” in their lives after SH ( Henwood, Redline, Semborski, et al., 2018 ). To this degree, the focus on independence and self-sufficiency in SH programming may not produce the intended results. Instead, programs may want to focus on strengthening community integration and supports which may better set a young person up for success in life after SH ( Holtschneider, 2016b ).

4. Discussion

This scoping review builds upon recent work that examined interventions intended to prevent or address youth homelessness ( Morton et al., 2020 ) by focusing specifically on housing interventions for young people experiencing homelessness. Unlike with the adult population experiencing chronic homelessness that tends to be older and has identified a single model as the best practice, we found studies over the past 20 years that focus on several models of housing for young adults (i.e., Transitional Housing Programs, including Foyers and Independent Living Programs; Supportive Housing; and Housing First). Although we found some differences regarding the structure of these programs (see Table 4 ), there remains a sense of confusion around how best to classify housing models and what they are implemented in practice ( Semborski et al., 2020 ). Additionally, findings of this review do not feature a more recent model of supportive housing being applied to young adults, Rapid Rehousing, though some evidence has been produced after 2018 (e.g., Hsu et al., 2019 ), a limitation of the current review, that underscores the ongoing experimentation to find appropriate housing interventions for young adults. Likewise, this review did not cover more untraditional models of housing for displaced young people, such as host homes (Petering, 2019), that are increasing in popularity and deserving of attention.

Overall findings suggest a relatively recent focus on housing programs for youth and young adults as a sub-population that experiences homelessness. Though some work was completed prior to 2012 ( Bridgman, 2001 ; Duncan et al., 2008 ; Dworsky, 2010 ; Fischer, 2000 ; Giffords et al., 2007 ; Kisely et al., 2008 ; Nolan, 2006 ; Rashid, 2004 ), the vast majority of inquiries into housing programs for young adult homelessness occurred after 2012 when youth and young adult homelessness was listed as a specific concern by the U.S. Interagency Council on Homelessness ( USICH, 2012 ; USICH, 2017 ). Therefore, it is fitting that the majority of studies utilized descriptive or qualitative approaches, as researchers and policymakers begin to understand the experience of homelessness among young adults. It is clear more evidence is needed, including use of more diverse methodologies. However, utilizing experimental or even quasi-experimental designs to understand housing environments proves to be quite difficult as it often requires manipulating the environment in which one is housed, often raising questions regarding ethics. Perhaps a comparative effectiveness design would probably be best rather than using something like a TAY triage tool to assign people to different housing resources when we don’t even know what model works best for whom

Prior to diversifying methods to understand age-appropriate housing interventions, there may be a need to further examine what age-appropriate housing interventions look like. Previous work has identified that housing interventions for this population have been borrowed from adult homelessness or foster care ( Semborski et al., 2020 ), as young adults experiencing homelessness are of college age and could be living in dorms. However, the extent which these studies framed or considered the issue of age-appropriateness in their evaluations is unclear and deserving of future attention.

It is increasingly clear that young adults who experience homelessness are unique, with service needs distinct from adults experiencing homelessness. Young adults in a study included in this review noted their desire for individualized support with flexibility and a supportive environment that contains support from peers ( Henwood, Redline, & Rice, 2018 ). It is clear from this review that a longer tenure in a housing environment with built-in support yields better outcomes at program exit ( Duncan et al., 2008 ; Kozloff, Adair, et al., 2016 ; Nolan, 2006 ; Pierce et al., 2018 ). Additionally, longer housing tenure has been associated with the application of HF in supportive housing settings ( Kozloff, Adair, et al., 2016 ), as well as other evidence-based practices, such as Positive Youth Development ( Gwadz et al., 2017 ; Leonard et al., 2017 ). Thus, we believe the most successful housing programs for young adults experiencing homelessness will likely be those that continually look to the evidence and adopt practices and policies with known and proven benefits specifically for at-risk and marginalized young adults.

Financial benefits of housing with built-in support services are well documented among adults consumers ( National Academies of Sciences et al., 2018 ) and has also been found among young adults ( Dodd et al., 2018 ). This review highlighted the vast array of services offered via the built-in supports in these housing environments ( Mares & Jordan, 2012 ), suggesting that interdisciplinary case management is likely to yield better results ( Giffords et al., 2007 ), compared to interventions that utilize a single case manager or consist of a mono-disciplinary team. Not only is housing tenure associated with increased positive outcomes at discharge, but engagement in the services offered in conjunction with housing has been proven to increase outcomes across a number of domains, including educational attainment, employment, life skills, and quality of life ( Gwadz et al., 2017 ; Pierce et al., 2018 ; Raithel et al., 2015 ; Rashid, 2004 ). However, in order to assess the effectiveness of services, it is recommended organizations use an outcome assessment tool ( Giffords et al., 2007 ) to systematically track progress and impact of their service delivery.

Despite the positives of these housing models, our review points to several inadequacies in the current housing climate. First, many communities have struggled with the funding to keep pace with service delivery due to the growing demands of young adult homelessness, including matching young adults with the appropriate level of care ( Steen & MacKenzie, 2017 ). This indicates that more housing with built-in supportive services is needed, but currently unobtainable due to funding deficiencies ( Dworsky, 2010 ). One recommendation for this issue offered by Dworsky (2010) is to form organizational partnerships between housing providers and other service providers. This would allow for comprehensive service provision from multiple providers, rather than a single provider required to offer both housing and supportive services. Triaging services in this way may reduce costs associated with these models of housing, increase flexibility of housing across a range of levels of need, as well as create separation between housing and services, further aligning with the HF philosophy which has been proven to increase housing tenure ( Kozloff, Adair, et al., 2016 ).

The articles reviewed also included discussion of subpopulations and their unique housing needs, which may not be adequately addressed by current models, namely young adults who identify as LGBTQ and parenting young adults. Though we note the array of services offered across housing models for young adults, there is a lack of LGBTQ-specific services and spaces ( Maccio & Ferguson, 2016 ; Prock & Kennedy, 2017 ), which is a colossal issue given that LGBTQ young people are at a heightened risk of experiencing homelessness, compared to their heterosexual and cisgender peers ( Morton et al., 2018 ). Likewise, outcomes among parenting young adults residing in housing with built-in support yielded mixed results, struggling more than non-parenting youth to achieve the same outcomes at discharge ( Fischer, 2000 ). Taken altogether, this evidence suggests that while housing programs for young people experiencing homelessness generally support improved outcomes, we also see age-specific service needs that are not being met by current service provision in these housing environments.

4.1. Limitations of our review.

The exhaustive scope of this review is both a strength and a limitation. While this scoping review covers decades of research, not many studies included in the final sample are within the last five years, posing a challenge as we seek to understand the current state of the literature. The process of reviewing housing interventions for homeless young adults seems to parallel the difficulty of defining “homelessness” among young adults. Thus, it has proven difficult to review housing programs because the target population has not been well defined or is fluid in definition. We chose to focus on studies of housing interventions for young adults experiencing homelessness, but may have incorrectly excluded sources because 1) defining the population has not been clear-cut, and 2) there may have been studies of other populations (e.g., foster care) that could be applied to and inform the questions explored in this study. Federal definitions of homelessness are generally focused on distinct aspects of the homeless episode, namely defining homelessness by sleeping location. Popular locations for young adults include unsheltered (e.g., sleeping in spaces not meant for human habitation), sheltered (e.g., emergency shelter or transitional housing), or staying with others (e.g., couch surfing/hopping or doubling up). Moreover, other definitions, such as the Runaway and Homeless Youth Act (RHYA), do not distinguish between different sleeping locations described here in their definition of homelessness. Instead the RHYA defines homelessness exclusively by the assessment of the situation, when “it is not possible to live in a safe environment with a relative, and who has no other safe alternative living arrangement” ( US Administration for Children & Families, 2009 ).

Beyond the discrepancies of what sleeping locations count as a homelessness episode, there is generally a lack of clarity regarding which young adults are included in the scope of homelessness. Specifically, youth exiting foster care are in an unique place with aging-out of transitional services and as many as 46% of former foster youth experience at least one episode of homelessness before the age of 26 ( Dworsky et al., 2013 ). Thus, Independent Living Programs for former foster youth may be strikingly similar to Transitional Housing Programs that have been applied as interventions for homeless young people, and at times they are one and the same, as some offer housing to both homeless and former foster youth simultaneously. The decision to narrow our focus to studies with majority homeless samples allowed for us to glean information on supportive housing specifically for homeless young adults, but may have also allowed for important information to be missed, specifically since some housing programs house both former foster youth and young people experiencing homeless, and at times these two populations are one and the same. Additionally, we may have missed relevant material due to a) only conducting our search in English, b) utilizing search terms common to experiences of homelessness in the United States, and c) the decision to exclude gray literature, and perhaps most notably. It is also important to note that there are several important studies that have been published since the end of our search period at the end of 2018. These findings highlight the importance of generating empirical evidence when possible to advance the field, inform direct service providers, and advise policymakers. Finally, despite the relative comprehensiveness of this review with two people reviewing each article at multiple steps, it is still possible that a study was mis-identified and not included.

Future directions

Through this review it is clear that young adults who experience homelessness are vulnerable, with higher rates of victimization and substance abuse and less education that older, adult homeless persons ( Kozloff, Stergiopoulos, et al., 2016 ); and though this review is international, all inquiries occur within metropolitan contexts. Thus, the generalizability of these findings to non-urban contexts is unknown and deserving of attention of future research. Additionally, the review of the included sources did not offer information about how the young adults got into housing, requirements for entry, or prioritization. While some communities have begun to implement a “best fit” approach (i.e., serving different youth with different program models), this review is unable to speak to this point. Debate around the specifics of acuity-based prioritization remains ( Rice et al., 2018 ). Understanding this information would increase the effectiveness of this review and the application of its findings. Future work should seek increase use of experimental designs, and perhaps more importantly comparative effectiveness designs, since we are not clear what type of housing works best and for whom ( Rice et al., 2018 ; Semborski et al., 2020 ); look at longer term outcomes; and work to establish clear recommendation for specific subpopulations of young adults experiencing homelessness.

5. Conclusion

Housing interventions for young adults experiencing homelessness remains a relatively new intervention to combat homelessness among younger demographics. While the evidence base continues to grow, there remains a need for quality research to generate empirical evidence in this area. Overall, studies included in this review showed promise for the development of best housing practices with this population. The findings from a small number of quasi-experimental and experimental studies point to the effectiveness of supportive housing interventions, but we conclude that the field lacks rigorous evaluative evidence to effectively establish a best practice, leaving a sense of confusion around multiple, somewhat specific, and at times competing, models of housing for young adults. However, prior to conducting rigorous research to prove and improve housing interventions for young adults, perhaps the first step is to gain clarity on the goal(s) of housing interventions for this population. While the broad goals of supportive housing may be independence and self-sufficiency of young adult residents ( Semborski et al., 2020 ), specific goals have yet to be put forth. Thus, an actionable first step may be to decide on what we ideally hope to be achieved through housing as an intervention for homelessness among young adults before future research agendas set out to prove it as a viable solution.

Despite the gaps in empirical evidence, we support previous conclusions urging us to not wait for an evidence-based best practice to fully guide policy and program design regarding housing homeless young people and instead recognizing access to housing as a fundamental human right ( Morton et al., 2020 ). Young adults with lived experience of homelessness have immediate needs for safe and adequate shelter that cannot wait and the experience to provide needed input to advance the field through informing both SH policy and program development. Evidence-based supportive housing for young adults will require the collaboration of community stakeholders, service providers, advocates, policymakers, and most importantly, young adults with lived experience.

Highlights:

• Across the 29 included articles, authors describe housing programs in terms of three models and/or housing philosophies: 1) Transitional Living Programs (TLP), Independent Living Programs (ILP), or Foyers; 2) Supportive Housing (SH); and 3) Housing First (HF). Most articles (n=20) featured TLPs, ILPs, or Foyers. Seven papers described their model as SH, and two described their model as HF.
• The majority of articles (n=11) were either of qualitative design or could be qualified as case studies and/or descriptive in nature (n=11), four were non-experimental, and three were quasi-experimental or experimental designs.
• Evidence from this review suggests that while housing environments for young people experiencing homelessness generally support improved outcomes, we also see age-specific service needs that are not being met by current service provision in these housing environments, particularly among LGBTQ and parenting young adults.
• Recommendations for providers: Continually seek evidence and adopt practices and policies with known and proven benefits specifically for at-risk and marginalized young adults, also known as evidence-based practices; and use outcome assessment tools to track progress and impacts of those practices.
• Recommendations for administrators, policymakers, and evaluators: Form organizational partnerships between housing providers and other service providers. This would allow for comprehensive service provision from multiple providers, rather than a single provider required to offer both housing and supportive services. Triaging services in this way may reduce costs associated with these models of housing, increase flexibility of housing across a range of levels of need, as well as create separation between housing and services, further aligning with the HF philosophy which has been proven to increase housing tenure

Supplementary Material

Appendix tables.

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Record numbers in the US are homeless. Can cities fine them for sleeping in parks and on sidewalks?

WASHINGTON — The most significant case in decades on homelessness has reached the Supreme Court as record numbers of people in America are without a permanent place to live.

The justices on Monday will consider a challenge to rulings from a California-based appeals court that found punishing people for sleeping outside when shelter space is lacking amounts to unconstitutional cruel and unusual punishment.

A political cross section of officials in the West and California, home to nearly one-third of the nation’s homeless population, argue those decisions have restricted them from “common sense” measures intended to keep homeless encampments from taking over public parks and sidewalks.

Advocacy groups say the decisions provide essential legal protections, especially with an increasing number of people forced to sleep outdoors as the cost of housing soars.

The case before the Supreme Court comes from Grants Pass, a small city nestled in the mountains of southern Oregon, where rents are rising and there is just one overnight shelter for adults. As a growing number of tents clustered its parks, the city banned camping and set $295 fines for people sleeping there.

The 9th U.S. Circuit Court of Appeals largely blocked the camping ban under its finding that it is unconstitutional to punish people for sleeping outside when there is not adequate shelter space. Grants Pass appealed to the Supreme Court , arguing the ruling left it few good options.

“It really has made it impossible for cities to address growing encampments, and they’re unsafe, unhealthy and problematic for everyone, especially those who are experiencing homelessness,” said lawyer Theane Evangelis, who is representing Grants Pass.

The city is also challenging a 2018 decision, known as Martin v. Boise, that first barred camping bans when shelter space is lacking. It was issued by the San Francisco-based 9th Circuit and applies to the nine Western states in its jurisdiction. The Supreme Court declined to take up a different challenge to the ruling in 2019, before the solidification of its current conservative majority.

If the decision is overturned, advocates say it would make it easier for cities deal with homelessness by arresting and fining people rather than helping them get shelter and housing.

“In Grants Pass and across America, homelessness has grown because more and more hardworking people struggle to pay rent, not because we lack ways to punish people sleeping outside,” said Jesse Rabinowitz, campaign and communications director for the National Homeless Law Center. Local laws prohibiting sleeping in public spaces have increased at least 50% since 2006, he said.

The case comes after homelessness in the United States grew by 12%, to its highest reported level as soaring rents and a decline in coronavirus pandemic assistance combined to put housing out of reach for more people, according to federal data. Four in 10 people experiencing homelessness sleep outside, a federal report found.

More than 650,000 people are estimated to be homeless, the most since the country began using the yearly point-in-time survey in 2007. People of color, LGBTQ+ people and seniors are disproportionately affected, advocates said.

Two of four states with the country’s largest homeless populations, Washington and California, are in the West. Officials in cities such as Los Angeles and San Francisco say they do not want to punish people simply because they are forced to sleep outside, but that cities need the power to keep growing encampments in check.

“I never want to criminalize homelessness, but I want to be able to encourage people to accept services and shelter,” said Thien Ho, the district attorney in Sacramento, California, where homelessness has risen sharply in recent years.

San Francisco says it has been blocked from enforcing camping regulations because the city does not have enough shelter space for its full homeless population, something it estimates would cost $1.5 billion to provide.

“These encampments frequently block sidewalks, prevent employees from cleaning public thoroughfares, and create health and safety risks for both the unhoused and the public at large,” lawyers for the city wrote. City workers have also encountered knives, drug dealing and belligerent people at encampments, they said.

Several cities and Democratic California Gov. Gavin Newsom urged the high court to keep some legal protections in place while reining in “overreach” by lower courts. The Martin v. Boise ruling allows cities to regulate and “sweep” encampments, but not enforce total bans in communities without enough beds in shelters.

The Justice Department also backed the idea that people shouldn’t be punished for sleeping outside when they have no where else to go, but said the Grants Pass ruling should be tossed out because 9th Circuit went awry by not defining what it means to be “involuntarily homeless.”

Evangelis, the lawyer for Grants Pass, argues that the Biden administration’s position would not solve the problem for the Oregon city. “It would be impossible for cities to really address the homelessness crisis,” she said.

Public encampments are not good places for people to live, said Ed Johnson, who represents people living outside in Grants Pass as director of litigation at the Oregon Law Center. But enforcement of camping bans often makes homelessness worse by requiring people to spend money on fines rather than housing or creating an arrest record that makes it harder to get an apartment. Public officials should focus instead on addressing shortages of affordable housing so people have places to live, he said.

“It’s frustrating when people who have all the power throw up their hands and say, ‘there’s nothing we can do,’” he sad. “People have to go somewhere.”

The Supreme Court is expected to rule by the end of June.