Martha R. Burt

This article describes the "rape myth" and tests hypotheses derived from social psychological and feminist theory that acceptance of rape myths can be predicted from attitudes such as sex role stereotyping, adversarial sexual beliefs, sexual conservatism, and acceptance of interpersonal violence. Personality characteristics, background characteristics, and personal exposure to rape, rape victims, and rapists are other factors used in predictions. Results from regression analysis of interview data indicate that the higher the sex role stereotyping, adversarial sexual beliefs, and acceptance of interpersonal violence, the greater a respondent's acceptance of rape myths. In addition, younger and better educated people reveal less stereotypic, adversarial, and proviolence attitudes and less rape myth acceptance. Discussion focuses on the implications of these results for understanding and changing this cultural orientation toward sexual assault.

This article explores three models of sexual harassment derived from previous research, court cases and legal defenses: the Natural/Biological Model, the Organizational Model, and the Sociocultural Model. Data from a large (N=20, 083) stratified random sample of the federal workforce are analyzed in relation to these models. No clear‐cut support for any one model emerges, and the picture of sexual harassment painted by these data appears to be more complex and varied than earlier, self‐selected samples initially suggested. The results are discussed in light of the difficulties of using large‐scale survey techniques to investigate complex cultural phenomena, and suggestions are made for future research approaches that could complement survey techniques.

Feminist analyses of rape hypothesize that adherence to rape myths affects the inclusiveness or restrictiveness of rape definitions, with numerous practical consequences. The results of this research support that hypothesis. The paper also critiques the experimental vignette methodology frequently used to investigate rape definitions. In the process of exploring its cectral hypothesis, this analysis demonstrates the importance and feasibility of using additional techniques to achieve a fuller understanding of factors affecting rape definitions.

To date, all research on rape recovery has focused on patterns of reduction in negative symptoms—primarily fear, anxiety, depression, and sexual dysfunction. This article reports the first systematic attempt to conceptualize and measure how women grow and change in constructive ways as a consequence of having to cope with a rape and its aftermath. Factor analysis of instruments developed for this research and completed by 113 rape victims yield six dimensions of self-concept, five dimensions of coping techniques, and three dimensions of self-ascribed change. Reliability and validity data for these factors are presented, and the results are discussed in terms of the relations among negative symptomatology, growth outcomes, and self-rating of recovery.

Journal Article Differences among Homeless Single Women, Women with Children, and Single Men Get access Martha R. Burt, Martha R. Burt The Urban Institute Correspondence to: Burt, Urban Institute, 2100 M Street, N.W., Washington, D.C. 20037. Search for other works by this author on: Oxford Academic PubMed Google Scholar Barbara E. Cohen Barbara E. Cohen The Urban Institute Search for other works by this author on: Oxford Academic PubMed Google Scholar Social Problems, Volume 36, Issue 5, 1 December 1989, Pages 508–524, https://doi.org/10.2307/3096815 Published: 31 July 2014

Back to table of contents Previous article Next article ArticleFull AccessImpact of Permanent Supportive Housing on the Use of Acute Care Health Services by Homeless AdultsTia E. Martinez J.D.Martha R. Burt Ph.D.Tia E. Martinez J.D.Search for more papers by this authorMartha R. Burt Ph.D.Search for more papers by this authorPublished Online:1 Jul 2006AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail Chronic homelessness in severely mentally ill and substance-abusing populations is a serious problem in the United States. Research demonstrates the persistent association of homelessness with increased morbidity, mortality, and victimization ( 1 , 2 , 3 ). Studies have also shown that homeless individuals with a diagnosis of concurrent mental and substance use disorders have more frequent use of emergency department and inpatient hospital services ( 4 , 5 ). The costs associated with the health consequences of chronic homelessness fall disproportionately on municipal and state governments. One promising approach to stemming these costs involves expanding the availability of permanent supportive housing. This article examines the impact of supportive housing on use of emergency department and inpatient services at a large urban public hospital by formerly homeless people with diagnoses of mental and substance use disorders. Past research suggests that supportive housing can offset certain costs associated with chronic homelessness. Research evaluating the New York-New York (NY/NY) Supportive Housing Initiative found that provision of supportive housing to homeless individuals with serious mental illnesses sharply reduced residents' use of services in eight public systems ( 6 ). Compared with members of a matched control group, clients in supportive housing showed reductions in service that were so substantial that cost savings nearly offset the entire $19,000 annual program cost. More recently, an evaluation of a joint Departments of Housing and Urban Development-Veterans Affairs program demonstrated that providing permanent supportive housing to homeless veterans resulted in better housing outcomes than intensive case management alone or standard care ( 7 ). Although the net costs of supportive housing in this program exceeded those in the NY/NY program, the cost per additional day housed compared favorably with other widely used psychiatric interventions. Finally, a smaller evaluation of the Connecticut Supportive Housing Demonstration Program found that adults with mental illness who were formerly homeless decreased use of acute, expensive health services after supportive housing placement ( 8 ). Although research has associated supportive housing with decreased service use, it is currently unclear whether such benefits extend to residents who abuse substances. The NY/NY program required clients to have made progress toward recovery from addictive or psychiatric problems before receiving supportive housing. In contrast, the Departments of Housing and Urban Development-Veterans Affairs housing program had no sobriety or treatment requirements, and researchers found that residential stability persisted for a subgroup of people who abused substances. Other studies, however, have reported that substance abuse negatively affects residential stability for formerly homeless adults with mental illness who participate in housing programs, in part because relapses may be grounds for eviction ( 9 , 10 , 11 , 12 ). One promising approach to providing supportive housing to people who abuse substances is the "low-demand" model, which does not require participation in treatment services or abstinence from drug or alcohol use as a condition of residency. Comparing this supportive housing model with a sobriety and treatment requirement model, researchers found that residents in a low-demand housing model had better housing outcomes without worsening symptoms of substance use or psychiatric disorders ( 13 ). This article focuses on a similar low-demand program in San Francisco, California, for homeless individuals with a dual diagnosis. It extends previous researchers' focus on housing outcomes to include service use outcomes. Specifically, this study tested hypotheses that receipt of supportive housing is associated with residential stability, reduced use of emergency department services, and reduced use of inpatient hospital services. In addition, it examined the mediating effects of substance abuse on service use outcomes. Analyses compared service use during the two years before supportive housing entry with use during the two to three years after entry. Case-control analyses were performed on a subsample of 100 people who received housing immediately (case group) and 25 people who were randomly assigned to a waiting list and entered supportive housing one year later (control group).MethodsThe sample included all 236 formerly homeless, disabled, single adults with disabilities who entered supportive housing at two San Francisco sites, Episcopal Community Services' Canon Kip Community House and Conard House's Lyric Hotel, between October 10, 1994, and June 30, 1998.Program description and eligibility criteriaCanon Kip Community House and the Lyric Hotel are supportive housing programs funded in part through the U.S. Housing and Urban Development Shelter Plus Care program. Canon Kip opened in October 1994 and has 104 units. The Lyric opened in April 1997 and has 57 units. Both buildings house residents in single-room-occupancy units and couple rent subsidies with an array of onsite services provided by a local interagency collaborative, including case management, psychiatric care, health care, and vocational training. Property management and clinical services staff at both buildings use a low-demand approach, in which all service receipt is voluntary and abstinence from drug or alcohol use is not a requirement of residency.Individuals were eligible to receive housing at either residence if they were living on the street or in a shelter and had at least two of the following disabilities: substance use disorder, mental illness (axis I or axis II diagnosis), and HIV-AIDS. To qualify for residence in the Lyric, one of the disabilities had to be a diagnosis of an axis I mental illness. A small proportion of Canon Kip units (nine units, or 9 percent) were allocated to individuals with only one diagnosis. A clinician confirmed all diagnoses in writing, and a social worker certified homeless status.Sample recruitmentThe San Francisco Department of Human Services allocated subsidized units at both residences through a housing lottery. An eight-month open-enrollment period preceded the time when units first became available, during which outreach workers went to local shelters, street sites, and food lines to enroll as many eligible homeless individuals as possible. Workers documented eligibility status and obtained the contact information of a person who could locate enrollees if they were chosen to receive the housing subsidy.The final waiting lists included nearly 3,000 eligible individuals. To distribute units impartially, the Department of Human Services used a computer program to randomly assign each person a waiting list number and then awarded the subsidies to those with numbers at the top of the waiting list. Thereafter, as residents moved out or died, individuals on the waiting list were chosen to occupy the units in order of their randomly assigned number.Data sources and measuresData on residents' service use between October 1992 and August 2000 were extracted from three administrative data sets. The San Francisco General Hospital and Community Health Network management information system provided comprehensive billing records for all general medical and psychiatric inpatient stays and emergency department visits to San Francisco's only public hospital. Each record included presenting diagnosis, procedures performed, presence and type of health insurance, total charges, and housing status at time of treatment. The San Francisco Department of Human Services provided demographic and diagnostic information about residents at the time of enrollment in the waiting list and at the time they moved into supportive housing. The agency also provided information on veteran status, employment, receipt of public benefits (Supplemental Security Income, Social Security Disability Insurance, general assistance, and veterans benefits), living situation immediately before move-in (street, shelter, or transitional housing), and if applicable, the date and context of exit from supportive housing. Community Substance Abuse Services provided a history of drug treatment by modality.Administrative data were aggregated to create a longitudinal service history for each study participant. Pre- and postintervention periods were constructed by using the individual's move-in date plus and minus six-month increments.All study participants completed informed consent procedures when entering supportive housing, permitting researchers to access their city-provided health and substance use service records. All procedures were reviewed and approved by the institutional review board at the University of California, Berkeley.Data analysisThe first analysis focused on the two years before and the two years after residents' initial move-in date, broken into six- and 12-month increments. For a smaller subsample (N=199) we extended the analysis to three years after the move-in date.Residential stability was assessed by measuring the percentage of residents still living in their unit one year and two years after move-in. For the smaller subsample, stability was also assessed three years after move-in. Differences in housing retention by whether participants had substance use disorder or mental illness were assessed with the chi square test.Changes in the probability of one or more service encounters were assessed by using McNemar's test statistic. Paired t tests were used to assess changes in the mean number of service encounters before and after move-in per 12- and 24-month period. Changes in the mean number of service encounters per six-month period were analyzed by using repeated-measures analysis of variance with time of measurement as a within-subjects factor.The original study design did not include a control group. Organizing data in relation to move-in date, such that each participant served as his or her own historical control, compensated in part for this design flaw. To establish the stability of service use before and after move-in and to rule out regression to the mean as an explanation for pre-post changes, we compared the four six-month periods before move-in to the six six-month periods after move-in.Because homeless people were randomly selected for supportive housing placement, we were able to construct a control group (N=25) for a subset of participants at Canon Kip Community House. The case group for this analysis included the first 100 residents who entered during the program's first year, all of whom were randomly assigned to the top of the waiting list. The control group included 25 individuals with slightly lower waiting-list numbers who entered supportive housing during the program's second year. Because most first-year residents (80 residents, or 80 percent) entered housing within the program's first three months, their first year in housing was roughly coterminous with the control group's first year before housing. Thus we compared service use between two groups of homeless single adults with disability, all of whom were interested in and eligible for supportive housing. Members of the case group were randomly assigned to immediate housing placement, and those in the control group were randomly assigned to continued homelessness. We aggregated service use indicators into year 1 (prehousing for both the case and control group) and year 2 (posthousing for the case group and prehousing for the control group).We used linear regression to model the mean difference in the number of service encounters between years 1 and 2 for the case and control groups. The main independent variable of interest was a dummy variable indicating receipt of supportive housing in year 2 (housing, 1, and no housing, 0). Before running the regression, we compared participants in the case and control groups on demographic and disability-related variables and tested for statistically significant differences by using the chi square test for categorical variables and the t test for continuous variables. We retained in the model all variables on which the two groups differed, using a criterion of an F with a p value less than .10 for inclusion (or t test for a single variable). These variables were race, veteran status, treatment for heroin addiction during the previous two years, living in a shelter when enrolled for supportive housing, and living in a short-term treatment facility when enrolled for supportive housing. We also included variables that were conceptually important, either on the basis of prior research or clinical expectations. These were age, gender, exited supportive housing, diagnosis variables (mental illness, substance use disorder, HIV, and single diagnosis only), one interaction term between substance use disorder and mental illness, and three interaction terms—between housing and mental illness, housing and substance use disorder, and housing and HIV. Following the NY/NY study, we included previous level of emergency service use to control for two possibilities: first, that previous service use levels would affect the magnitude of pre-post change, and second, that previous service use would affect the probability of subsequent service use ( 6 ). With the exception of interaction terms, all variables were entered simultaneously. The four interaction terms were each entered separately; the final model included only one that was statistically significant. ResultsStudy participants were primarily male (173 participants, or 73 percent). More than half were African American (126 participants, or 53 percent), 76 (32 percent) were white, 18 (8 percent) were Latino, 11 (5 percent) were Native American, and five (2 percent) were Asian. The median age was 43, and the mean±SD age was 44±8.7. At the move-in date, all participants had been homeless for at least eight months, and most had been homeless much longer. Using city public health system data, we identified 139 participants (59 percent) as being homeless two to eight years before their move-in date. Participants entered supportive housing from shelters (152 participants, or 64 percent), the streets (68 participants, or 29 percent), or short-term treatment facilities (16 participants, or 7 percent).All participants had documented disabilities at the time of move-in. Most (178 participants, or 75 percent) had diagnoses of both substance use and mental disorders, 16 (7 percent) had diagnoses of both substance use disorder and HIV, four (2 percent) had diagnoses of both mental disorder and HIV diagnoses, and 11 (5 percent) had triple diagnoses of HIV, substance use disorder, and mental disorder. A small proportion of participants had single diagnoses only: nine (4 percent) had substance use disorder, and 11 (5 percent) had mental disorder. Diagnosis data were missing for seven participants (3 percent). In total, 214 (91 percent) were given a diagnosis of current or past substance use disorder, 204 (86 percent) were given a diagnosis of mental illness, and 31 (13 percent) were given a diagnosis of HIV-AIDS.A total of 192 participants (81 percent) stayed in supportive housing for at least one year, 149 (63 percent) stayed at least two years, and of the subset of participants with three years of data (N=199), 95 (48 percent) stayed at least three years. There were no significant differences in retention at year 1 or year 2 by substance use disorder, mental illness, or concurrent substance use disorder and mental illness (results not shown).Nearly all study participants (224 participants, or 95 percent) used publicly funded health services in San Francisco during the 24 months before moving into supportive housing.Table 1 describes study participants' emergency department visits and inpatient admissions at San Francisco's public hospital for two 12-month increments before they moved into supportive housing (13 to 24 months before move-in and one to 12 months before move-in) and two 12-month increments after moving into supportive housing (one to 12 months after move-in and 13 to 24 months after move-in). Between the one-to-12-month period before move-in and the one-to-12-month period after move-in, participants showed significant declines in the percentage with any emergency department visit (from 53 to 37 percent), mean number of emergency department visits (from 1.94 to .86 visits per resident), and total number of emergency department visits (56 percent decrease, from 457 to 202). Across these two time periods, participants also showed significant declines in the percentage with an inpatient admission (19 to 11 percent), mean number of inpatient admissions (.34 to .19 admissions per resident), and total number of inpatient admissions (45 percent decline, from 80 to 44). No statistically significant differences were found on any measure of emergency department or inpatient use between consecutive pre-move-in periods (13 to 24 months before move-in and one to 12 months before move-in) or post-move-in periods (one to 12 months after move-in and 13 to 24 months after move-in). Table 1 Use of public services before and after receipt of supportive housing among 236 homeless adults with mental illness, substance use disorder, and other disabilitiesTable 1 Use of public services before and after receipt of supportive housing among 236 homeless adults with mental illness, substance use disorder, and other disabilitiesEnlarge tableTable 1 also shows emergency department visits and inpatient admissions stratified by type of service (medical compared with psychiatric). When the data were stratified, study participants showed statistically significant declines in three measures of emergency department use: the percentage with any medical emergency department visit, mean number of medical emergency department visits, and mean number of psychiatric emergency department visits. There were no changes in measures of inpatient admissions when the data were stratified by type of service, resulting in part from low sample size. For a subsample of 199 residents, we analyzed emergency department visits and inpatient admissions for 36 months after move-in in six-month increments. Figure 1 shows a pattern of uniformly high emergency department use during the four six-month periods before move-in, followed by lower emergency department use during the six six-month periods after move-in. Figure 2 shows a similar pattern for inpatient admissions. The main effect of time of measurement was significant for both mean emergency department visits and inpatient admissions. Tests of within-subjects contrasts showed a significant decrease in both mean emergency department visits (F=16.96, df=1, 198, p<.001) and mean inpatient admissions (F=4.42, df=1, 198, p<.05) from one to six months before move-in to one to six months after move-in. There were no significant changes in emergency department visits or inpatient admissions between consecutive pre-move-in or post-move-in periods. Figure 1 Mean number of emergency department visits per six-month period among 199 homeless adults with mental illness, substance use disorder, and other disabilities aa Significant effect of time across all ten periods; F=3.82, df=9, 190, p<.001 Figure 2 Mean number of hospital admissions per six-month period among 199 homeless adults with mental illness, substance use disorder, and other disabilities aa Significant effect of time across all ten periods; F=2.32, df=9, 190, p<.05 Finally, we conducted case-control analyses of individuals randomly assigned to immediate supportive housing placement (100 participants in the case group) or a waiting-list condition (25 participants in the control group). Figure 3 shows that in univariate analysis, participants in the case group experienced significant decreases between year 1 and year 2 in both the probability of any emergency department visit and mean number of emergency department visits. Participants in the control group experienced no significant changes on either of these measures. Measures of inpatient admission did not change significantly for either group, although participants in the case group experienced nonsignificant decreases in the probability of an inpatient stay (17 participants, or 17 percent, to nine participants, or 9 percent) and mean inpatient days (.24 compared with .15), whereas participants in the control group experienced nonsignificant increases in both measures (two participants, or 8 percent, compared with four participants, or 16 percent). Figure 3 Changes in emergency department use from year 1 to year 2 among 100 participants in the case group who received supportive housing in year 1 and 25 participants in the control group who did not receive supportive housing until year 2 Multivariate analysis showed that observed differences in emergency department use persisted after the analysis controlled for baseline differences between groups ( Table 2 ). Also significant were substance use disorder and substance use disorder by receipt of housing. Combined, the effect of the substance use disorder variable and the substance use disorder by receipt of housing variable was .30. Additional significant variables in the model were veteran's status, number of emergency department visits in year 1, and exit from supportive housing during year 1. No differences in inpatient stays were found in multivariate analysis. Table 2 Case-control model of predictors of change in the number of emergency department visits from year 1 to year 2 among 100 participants in the case group who received supportive housing in year 1 and 25 participants in the control group who did not receive supportive housing until year 2 aa Adjusted R 2 =.73, df=18, 106 Table 2 Case-control model of predictors of change in the number of emergency department visits from year 1 to year 2 among 100 participants in the case group who received supportive housing in year 1 and 25 participants in the control group who did not receive supportive housing until year 2 aa Adjusted R 2 =.73, df=18, 106 Enlarge tableDiscussion A majority of homeless adults in this study achieved residential stability supportive housing, despite the high prevalence (91 percent) of substance use disorder. The one-year and two-year retention rates (81 and 63 percent) are similar to those previously reported ( 9 , 11 , 14 ), and they support findings from the Housing and Urban Development-Veterans Affairs study that even in the absence of sobriety requirements, supportive housing provides substantial housing stability for clients with a diagnosis of substance use disorder. However, unlike previous studies, we found no relationship between substance use disorder and housing retention outcomes ( 9 , 10 , 11 , 12 ). This may be due the relatively small proportion percent) of participants without substance use disorder in our sample. We also found significant effects supportive housing placement on the percentage with any emergency department visit, average number visits per person, and total number of emergency department visits for the sample as a whole. Supportive housing also reduced the probability of hospitalization and mean number of admissions per person. Case-control analyses showed significant declines in the percentage with any emergency department visit and the mean number of emergency department visits for participants in the case group but not for those in the control group. In addition, multivariate analysis of participants in the case group and those in the control group demonstrated an increase in emergency department visits associated with exiting supportive housing, suggesting that service use reductions are tied directly to remaining in housing. We were unable to detect statistically significant changes in inpatient stays—a finding that may be explained by the small sample. Sample size limitations also precluded our ability in case-control analysis to analyze changes in medical and psychiatric emergency department visits separately.Similar to the results of previous studies, our results showed that after the analyses controlled for all other factors, the reduction in emergency department visits associated with receipt of housing was lower for participants with substance use disorder than for those without substance use disorder. The small number in our control group in our case-control model (N=25) and the small number of participants who did not abuse substances (22 participants, or 9 percent) limited our ability to fully explore what drives these differences. More quantitative and qualitative research is needed to understand the moderating effect of substance use disorder on the reduction in emergency department use among permanent supportive housing residents. Nevertheless, our finding of significant, though reduced, drops in service use in the 91 percent of residents with a diagnosis of substance use disorder extends findings from the NY/NY study by demonstrating that clients offered supportive housing while actively using substances can reduce service use. Our findings suggest that part of the cost of supportive housing may be offset by relieving the cost burden of homeless adults with disability on public systems of care. We estimate that the service reductions reported in this study translate into public cost reductions of $1,300 per person moving into permanent supportive housing per year for the first two years after move-in, offsetting at least 10 percent of the estimated annual cost of supportive housing in San Francisco ( 15 ). These savings do not approach the high cost offset reported in the NY/NY study. However, our study focused on only one of the eight health, shelter, and corrections systems included in that study and consequently excluded a broader range of service data that may have increased cost savings. In addition, we omitted quality-of-life measures that may have justified additional costs. This study was limited by its non-experimental, case-control design and its reliance on administrative data collected for nonresearch purposes. In addition, we were unable to identify which components of supportive housing may have driven the observed decreases in service use—housing, on-site services, or both ( 7 , 16 , 17 ). However, our methods were less costly than those used in the NY/NY initiative, totaling $55,000 compared with $450,000 for the NY/NY analysis ( 18 ). These methods are thus more accessible to communities interested in examining their own patterns of expenditure and weighing the benefits of developing long-term solutions to homelessness. Conclusions Despite its limitations, this study associated supportive housing placement with significant reductions in crisis service use. It showed that supportive housing can accomplish a number of specific policy goals, namely ending homelessness by providing a stable residential setting and reducing emergency department and inpatient hospital use in populations with mental illness and substance use disorder who lived largely on the streets ( 13 , 19 ). As such, it demonstrated that public hospital savings can offset part of the costs of providing supportive housing to this population. AcknowledgmentsThis project was supported by funding from the California Endowment and the Robert Wood Johnson Foundation. The authors thank the following individuals for their invaluable contributions to this project: Carol Wilkins, M.P.P., Stephen Metraux, Ph.D., Clare Sears, Ph.D., Kelly Wilkinson, M.S.W., Seth Katzman, Lauren Hall, Margot Kushel, M.D., Mitchell Katz, M.D., Judith Klain, Anson Moon, Trent Rhorer, M.P.P., Dariush Kayhan, Shelagh Little, Peter Silen, Ph.D., and the residents of both Canon Kip and the Lyric.Ms. Martinez is affiliated with the Goldman School of Public Policy, University of California, Berkeley, and with the Bridgespan Group, 1 Embarcadero, Suite 35, San Francisco, California 94111 ([email protected]). Dr. Burt is affiliated with the Urban Institute, Washington, D.C.References1. Barrow S, Herman D, Cordova P, et al: Mortality among homeless shelter residents in New York City. American Journal of Public Health 89:529-534, 1999Google Scholar2. Kushel M, Evans J, Perry S, et al: No door to lock: victimization among homeless and marginally housed persons. Archives of Internal Medicine 163:2492-2499, 2003Google Scholar3. Kasprow W, Rosenheck R: Mortality among homeless and non-homeless mentally ill

Using data from a nationally representative sample of 50 rape crisis centers, this article investigates the range of center types, services offered, staffing, involvement in community networks, funding and affiliation with criminal justice, counseling, and human services agencies. The evolution of the rape crisis center from the few prototype centers opened in 1972 to the many different models existing today is traced. The most important finding is that rape crisis centers today do not fall neatly into types. Rather, they have developed to fit their communities, making choices about whom to serve, where to locate a service, how to work with other agencies in the community, how, when, and where to do community education, and how to establish financial security. A decision about one such dimension does not necessarily predict what the decision will be about the other dimensions.

The information in this report is critical to discussions about effective public policy responses needed to break the cycle of homelessness. As such, it provides an important baseline and foundation for future assessments of the nature and extent of homelessness. It also provides a valuable overview that will improve our understanding of the characteristics of homeless people who use services, the nature of homelessness, and how best to address it.

Study goals were to assess if community agency interactions, the characteristics of services provided by staff, and the combinations of services received can predict women's perceptions of victim service helpfulness around domestic violence and sexual assault. Data were collected from agency representatives in 26 communities, and both women who used services and others living in the community ( n = 1,509 women). Women found nonprofit victim services more helpful based on staff behavior in those agencies and the extent to which women felt control when working with staff; helpfulness of services was enhanced when agencies interacted with the legal system and other community agencies.

The literature on adolescent risk is reviewed, a model of risk that emphasizes risk antecedents and markers is proposed, and an overview is presented of an emergency service delivery strategy that integrates services, emphasizes interagency coordination, and addresses the full range of service needs for youth at risk. Highlights of programs currently in operation are described.

This study examines the extent to which programs for domestic violence and sexual assault gear services toward women facing multiple barriers (i.e., substance abuse disorders, mental health problems or learning disabilities, incarceration, and prostitution) and the unique problems such women encounter when accessing services. As part of a national evaluation, the authors interviewed staff from 20 programs focusing their service efforts on multibarriered women. Problems encountered by such women include lack of services dealing with multiple barriers, uneducated service providers, and batterers using women's barriers to further control or victimize them. This article describes the strategies programs use to meet these women's distinct needs.

To discuss the frequent failure of the United States (and other countries) to make the types of investment in youth that would increase the future prospects of youth from high-risk backgrounds. I argue that these investments are worth making, and describe the types of research and knowledge dissemination that will be necessary to promote such investments.I begin with a framework for thinking about and working with adolescents. I review theories of youth development, the developmental tasks of adolescence, risk and resilience, and the strong tendency of current approaches to address single problems and symptoms rather than underlying conditions. A conceptual framework is presented that combines known elements of risk and protective factors, such as antecedents, system markers of current or potential difficulties, risk behaviors, and outcomes. I briefly review what we know about youth risk behavior and outcomes in various domains, including combined prevalence and patterning. I then examine what we know about the payoffs that we can expect from investing in activities that promote adolescent health. I end with a set of recommendations for researchers and practitioners, and discuss the information that they need to put these recommendations into practice.

Drawing on a nationally representative sample of interviews with homeless people who use services and with service providers in several large cities, the authors explore the efforts of various states and localities to provide emergency services to homeless people, to help them get out of homelessness, and to prevent homelessness. They find that services and programs to help people work their way out of homelessness are not well developed and that the level of interest in finding solutions and the levels of funding to create these solutions vary greatly from state to state.

The History of Comprehensive Service Integration Defining Adolescence and Risk A New Conceptual Framework for Understanding Risk Integrated Services - Initiatives Big Brothers Big Sisters of Greater Miami Teen Connectors The Belafonte-Talcolcy Centre, Inc. Oasis Centre Chins Up Youth and Family Services Houston Communities in Schools I Have a Future Garfield Youth Services Centre for Family Life Service Integration and Other Cross-Cutting Issues Evaluating Programmes Offering Integrated Services and Actitivies to Youth Financing Integrated Services Programmes Summary and Conclusions.

This article summarizes the findings of a study of community-wide strategies for preventing homelessness among families and single adults with serious mental illness, conducted for the US Department of Housing and Urban Development. The study involved six communities, of which this article focuses on five. A major finding of this study was that it was difficult to identify sites with community-wide strategies, and even harder to find any that maintained data capable of documenting prevention success. However, the five communities selected for this study presented key elements of successful strategies including mechanisms for accurate targeting, a high level of jurisdictional commitment, significant mainstream agency involvement, and mechanisms for continuous system improvement.

A formula for making national, state and local estimates of the cost to the public of teenage childbearing is derived from a review of 12 studies. The formula is then applied to U.S. data. The calculations yield a single-year cost for 1985 of $16.65 billion paid through three programs--Aid to Families with Dependent Children, food stamps and Medicaid--for women who first gave birth as teenagers. The calculations also show that the public will pay an average of $13,902 over the next 20 years for the family begun by each first birth to a teenager in 1985 and $5.16 billion over the same period for the families of all teenagers experiencing a first birth in 1985. If all teenage births were delayed until the mother was 20 or older, the potential savings to the public would be $5,560 for each birth delayed and $2.06 billion for the entire cohort of teenagers who would otherwise have had a first birth in 1985.Estimates of public outlays for teenage childbearing often afftract a great deal of attention in the US media, at both the national and the local level. Such estimates are time-consuming but not difficult to calculate, and enough is known about how to make them that such figures should become readily available to policy-makers and program-planners throughout the USA. A formula for making national, state and local estimates of the cost to the public of teenage childbearing is derived from a review of 12 studies. The formula is then applied to US data. The calculations yield a single-year cost for 1985 of US$16.65 billion paid through 3 programs--Aid to Families with Dependent Children, food stamps and Medicaid--for women who 1st gave birth as teenagers. The calculations also show that the public will pay an average of US$13,902 over the next 20 years for the family begun by each 1st birth to a teenager in 1985 and US$5.16 billion over the same period for the families of all teenagers experienceing a 1st birth in 1985. If all teenage births were delayed until the mother was 20 or older, the potential savings to the public would be US$5560 for each birth delayed and $2.06 billion for the entire cohort of teenagers who would otherwise have had a 1st birth in 1985.

Homelessness did not disappear in the 1990s, despite the nation?s economic boom. In fact, it appears to have increased. On any given day, at least 800,000 people are homeless in the United States, including about 200,000 children in homeless families. These startling statistics, however, do not tell the whole story.

Homelessness has now been on the American policy agenda for close to two decades. In 1989, when the Urban Institute published America's Homeless, by Martha R. Burt and Barbara Cohen, policymakers and the public may have hoped that we could end the crisis relatively quickly. The arrival of the new millenium has not fulfilled that expectation. In this new volume, Helping America's Homeless, Martha Burt and coauthors returns to the problem with the most in-depth analysis of homelessness that has ever been published. Drawing on data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC), and extending their pioneering work, the authors examine every aspect of the issue, from how many homeless people there are, where they are, why they became homeless, to how long their homelessness lasts. They explore the programs that provide assistance to the homeless, and how they are configured within communities of different sizes. Finally, the authors look at how policymakers have approached this problem, and our prospects for solving the crisis in the new millenium.

Abstract The first question people typically ask about homelessness is, “How many people are homeless?” After that, questions usually turn to characteristics: “What are they like?” Basic demographic characteristics such as sex, age, family status, and race have always been of interest, in part because the homeless population appears to be very different from the general public and even from most poor people who are housed with respect to these characteristics. Often, because these differences are so dramatic, demographic characteristics are overinterpreted as representing the reasons for homelessness. But as various studies have documented, most demographic factors quickly disappear as proximate causes when other factors representing personal vulnerabilities are available for examination. The underlying causes of homelessness, the structural conditions of housing and labor markets that turn vulnerabilities into loss of housing, do not lie within individuals at all and are thus difficult to include in analyses based on individual data.

Abstract This article presents an analysis of the factors that predicted 1989 homelessness rates in large U.S. cities. Data were collected to describe homelessness rates in the 182 cities with populations over 100,000. In addition, variables were assembled to represent many factors that have been hypothesized to cause homelessness, including each city's housing and income conditions, household resources, employment conditions, employment structure, available public benefits, and cost of living. The researcher used regression analysis to assess the impact of each hypothesized causal factor on between‐city differences in 1989 homelessness rates for the 147 primary cities in the data set (excluding suburbs) and for subgroup breakouts based on level of manufacturing employment and population growth from 1980 to 1986. The article ends with a discussion of policy implications of the patterns discovered.

This report identifies six community-wide approaches to preventing homelessness, three focused on families, two focused on people with serious mental illness, and one focused on youth. It describes four elements common to successful programs: (1) the ability to target people seriously at risk of homelessness; (2) the motivation to invest resources for prevention; (3) mechanisms for maximizing resources by collaborating with non-housing agencies such as child welfare and mental health; and (4) leadership that sets goals, develops strategies, and uses data to track progress, provide feedback, and support improvements.

This study investigated factors affecting compliance, to orders from a formal authority. The design created a two-level status hierarchy in which subjects occupied identical low-status positions and responded to demands from a simulated high-status leader. Four components of authority-normativity,coervice power, collective justification, and success-failure-were manipulated as independent variables. Another component, the endorsement accorded the leader, was included in the design as a measured variable. Results indicated that compliance increased significantly when coervice power was high (rather than low), when justification was collective (rather than partisan), and when demands were normative (rather than counternormative). Contary ti the theoretical expectation, endorsement did not affect compliance by low-status members. The findings show that the normative aspect of legitimacy serves as a compliance-gaining base even when stripped of enforcing sanctions and under-lying goals and that the distinction between normativity and endorsement is valid for research on social power.

A commitment to ending homelessness was the impetus behind a federal initiative that funded five demonstration projects for people with mental illness and chronic homelessness. The projects combined two evidence-based practices—supported employment and supportive housing. An evaluation of one of the projects, LA’s HOPE, found that it was highly successful in quickly moving clients into permanent supportive housing. More than half (57%) found competitive jobs—a high rate for individuals who had been homeless for a long time and who had substantial psychiatric disabilities.

This report presents the results of a project that examined coordinated community responses to domestic violence and focuses on communities that are attempting to incorporate non-justice system services and stakeholders into their responses. It details each community's efforts, including the history, features, and outcomes of the coordination. The report also discusses how the communities created change, the mechanisms used, and the opportunities for further efforts. The report concludes with a summary of important issues for communities to consider in coordinating a response to domestic violence that includes a broad range of organizations and stakeholders.

This project identifies and describes seven community-wide approaches to ending chronic street homelessness that are working in cities around the country. Elements that appear to maximize progress include a paradigm shift in the goals and approaches of the homeless assistance network; setting a clear goal of reducing chronic street homelessness; committing to a community-wide level of organization; having leadership and an effective organizational structure; having significant resources from mainstream public agencies that go well beyond homeless-specific funding sources; commitment and support from mayors, city and county councils, and other local elected officials; and having a mechanism to track progress, provide feedback, and support improvements. This report describes these common elements and their role in approaches to reducing chronic street homelessness. Communities just beginning to develop their own plans for reducing chronic homelessness should be able to find illustrative practices and programs that they can learn from and adapt to their own situations.

Given the magnitude of public and private efforts to supply those in need with food at emergency feeding sites, it might be assumed that homeless people do not have a problem getting adequate amounts of food. Results from a nationally representative study of 1,704 homeless adults and 400 soup kitchen and shelter providers in 20 cities with populations of 100,000 or more show that, for many homeless individuals, hunger or food security is a problem. Although the majority of providers serve meals on five to seven days per week, meal observations show that the average meal served provided 1,000 kcals and was low in fruits, vegetables and dairy products. Twenty-four hour food lists of the individuals' intakes show that people using services eat two or more meals per day but only meet the USDA recommendations for meats or meat alternatives. Their diets are particularly low in fruits, vegetables, grains and dairy products. Although solutions include increasing the quantity and quality of food available to homeless people, as well as increasing the availability of housing, it is most important to address the general problems of poverty that play a major role in keeping people in a homeless condition or without adequate resources. Étant donné les efforts déployés dans le secteur public et para-public en vue de fournir des aliments aux personnes démunies, par l'intermédiaire de centres de dépannage, on pourrait croire que les sans-abris sont en mesure d'obtenir suffisamment de nourriture. Les résultats d'une étude nationale représentative, menée dans 20 villes ayant une population de 100 000 habitants ou plus, auprès de 1704 adultes sans-abris et de 400 intervenants oeuvrant dans des cantines et refuges d'urgence, démontre que la faim et l'insécurité alimentaire constituent un état de fait pour nombre d'entre eux. Quoique la plupart des opérations servent des repas de cinq à sept jours par semaine, l'observation révèle que le repas moyen contient 1000 calories et offre peu de fruits, de légumes et de produits laitiers. Le relevé des aliments consommés durant la journée indique que les personnes utilisant ces services consomment deux repas ou plus par jour mais ne rencontrent les recommandations du USDA que pour les viandes et les substituts. Leur alimentation est particulièrement inadéquate en fruits et légumes, en produits céréaliers et en produits laitiers. Une augmentation du nombre des logements de même qu'une amélioration qualitative et quantitative des repas offerts aux sans-abris s'imposent mais il est avant tout essentiel de combattre la pauvreté qui joue un rôle déterminant dans le maintien des sans-abris et dans le manque de ressources. Dada la magnitud de los esfuerzos públicos y privados para distribuir alimentos en los centros de distribución de emergencia a aquéllos que los necesitan, se podría suponer que las personas sin hogar no tienen problemas para abastecerse de cantidades suficientes de alimentos. Los resultados de un estudio en una muestra representativa de 1704 adultos sin hogar y de 400 cocinas y refugios en ciudades de 100 000 habitantes y más de los Estados Unidos, muestran que la seguridad alimentaria y el hambre son un problema para muchos de estos adultos. Aún cuando la mayoría de los centros de distribución de alimentos sirven comidas de cinco a siete días por semana, se observó que estas comidas proveían en promedio 1000 kcal, y que eran pobres en frutas, verduras y productos lácteos. Los datos sobre ingesta mediante encuestas de recordatorio de 24 horas muestran que los usuarios de estos centros, aún cuando ahí comen una o dos veces, solamente cubren las recomendaciones de carnes y substitutos cárnicos propuestas por el Departamento de Agricultura de los Estados Unidos (USDA). Sus dietas son particularmente pobres en frutas, verduras, granos y productos lácteos. Aún cuando algunas soluciones incluyen el aumentar la disponibilidad de alimentos en cantidad y calidad adecuadas, así como el acceso a vivienda para estas personas sin hogar, lo más importante es atender los problemas generales que mantienen a estas personas sin hogar y sin recursos apropiados.

The STOP Violence Against Women Formula Grants Program is a federal funding stream that promotes institutionalized system change in communities, such that women victims of violent crime can encounter a supportive and effective response from the criminal and civil justice systems and from victim service (VS) programs. This analysis assesses the degree to which receipt of STOP funding for nonprofit VS programs and state-level STOP program support for collaboration has led to greater community interaction and legal system outcomes. It also examines whether types of interaction among community agencies are related to post-STOP legal system responses to victims. Changed interactions among nonprofit VS programs, law enforcement, and prosecution staff members seem to lead to changes in the legal system's approach to handling domestic violence and sexual assault cases. They also assist communities in meeting the needs of victims.

In 1972 there were fewer than 10 nonpsychiatric adult day care centers in the United States; by late 1982 there were 1,000 or more. This development of programs as an alternative to nursing home and hospital care of impaired adults has been haphazard. Complications from surveys, field visits, and regulatory agencies reveal a lack of elements for systematic evaluation of the real costs and benefits. Future policies must also recognize that adult day care has become a new service without significantly diminishing institutional use.

Federal legislation to support the development of transitional housing programs for homeless people (TH) was first introduced in 1986, and ultimately incorporated into the first Stewart B. McKinney Act in 1987 as part of the U.S. Department of Housing and Urban Development’s (HUD) Supportive Housing Program (SHP). HUD’s division of Community Planning and Development has had responsibility for the SHP since 1989, when a new administration brought all the McKinney Act housing programs together within the new Office of Special Needs Assistance Programs, which manages and directs the program. By 1996 there were about 4,400 transitional housing programs offering about 160,000 beds (Burt et al. 1999). By 2007 there were almost 7,300 transitional housing programs offering about 211,000 beds. About 53 percent of the TH beds reported in 2007 are designated for families (HUD 2008), creating a capacity to serve about 40,000 families at a time.

Rapid re-housing is a homeless assistance strategy that provides homeless families with immediate, temporary assistance to help them return to permanent housing and to promote their housing and economic stability. This approach has been growing in popularity for 10 years. In 2007, in response to the growing emphasis on rapid re-housing, the U.S. Congress appropriated $23.75 million for the Rapid Rehousing for Homeless Families Demonstration (RRHD) program. As part of its 2008 competitive application for McKinney-Vento Homeless Assistance Act funding, the U.S. Department of Housing and Urban Development (HUD) awarded RRHD grants to 23 communities to serve homeless families with moderate barriers to housing.

The goals of the current study were to assess if domestic violence and sexual assault case outcomes and women’s perceptions of legal system response can be predicted by the level of interaction between community agencies and the level of legal system response after communities receive STOP funding. A total 1,509 interviews were conducted with women living in 26 communities. Two samples were included: (a) a Help Seeker sample recruited from nonprofit victim service agencies and their legal system agency partners, and (b) a Community sample of women ages 18 to 35 recruited through random digit dialing of households. Results show that women’s perceptions of whether community agencies were working together to assist her and her case significantly and positively related to arrests in domestic violence and sexual assault cases and to convictions in domestic violence cases. It also increases women’s beliefs that law enforcement and prosecution are effective agencies.

The research reported in this paper tests three theoretical descriptions of the relative impact of childhood and later socialization experiences on adult behavior, using the specific context of female sexual socialization. The theories tested are derived from Freud, Brim, and Gagnon and Simon. Two aspects of adult sexual behavior serve as dependent variables: sense of sexual vulnerability toward strangers, and ability to cope with problems in serious intimate relationships. Results indicate that no single theory adequately accounts for the data. The importance of postchildhood experiences for the stable personality trait of sexual self-esteem in these data raises serious questions about theories which assume the primacy of early experiences for personality formation, especially in the sexual area. Substantively, the models can explain much more of the variance in sexual vulnerability than in coping ability. This finding supports the expectation that these two dependent variables respond to different antecedents, and deserve separate treatment in socialization research.

The U.S. Department of Housing and Urban Development (HUD) has been funding transitional housing, permanent supportive housing, and related supportive services projects for homeless people since 1988, under the authority granted by the Stewart B. McKinney Homeless Assistance Act of 1987 and its subsequent modifications. When HUD began funding these projects under its Supportive Housing Program (SHP) as competitive grants, and later (starting in 1996) through the Continuum of Care (CoC) process, it gave applicants discretion to use HUD homeless funds for whatever mix of eligible activities they preferred. As a result, by 2000, nearly 60 percent of HUD homeless funds were being used by communities for services such as daycare and drug treatment, while the remaining funds were used for housing.

Several factors affect Wright and Devine's efforts to estimate the size of the homeless population. The most critical ones are the purpose of the estimate, implicit or explicit definitions of homelessness used in the estimate, and the time period covered by the data sets used in the calculations.

This report examines the development, current structure, and likely future of Continuums of Care (CoCs) for homeless people throughout the United States. It describes how communities organize themselves to respond to homelessness, how they identify needs and plan their strategies, and how the U. S. Department of Housing and Urban Development's requirement that communities submit a single, community-wide, coordinated application for funding has affected the development of homeless networks and services. Involvement of mainstream agencies (e.g., housing, mental health, veterans affairs) and the ease or difficulty of navigating the service system from a client's perspective is also examined. Information comes from case studies of a sample of 25 CoCs scoring highly on ratings of their annual funding applications.

Abstract The Program Environment Scale (PES) was developed for use with clients of community‐based programs for the severely mentally ill. It is intended to fill the gap in available tools for assessing clients' perceptions of program functioning as it affects their “quality of life” in a program. Formal pretests were conducted with 121 clients at 12 randomly selected programs near Washington, DC. The final field test used a revised form (29 domains; 129 items) with 221 clients in 22 programs selected randomly throughout the U.S., including Clubhouse, day treatment, psychosocial rehabilitation, and social club programs. Twenty‐three subscales met at least five of eight psychometric criteria for internal consistency and discriminant validity. A 24th subscale was retained because of its substantive importance. Successful subscales cover program atmosphere and interactions (program cares about me, energy level, friendliness, openness, staff‐client and client‐client respect, reasonable rules, availability of positive physical contact, protection from bad touch, staff investment in their jobs, and confidentiality), client empowerment/staff‐client equality (program and treatment empowerment, egalitarian space use), and service components (support for paid work, work importance, emergency access, family activities, housing, public benefits, community activities, medications, substance abuse, and continuity). Subscale validity is indicated by associations of specific service offerings with scores on scales measuring client perceptions of those services, and by an ability to differentiate among program models (i.e., Clubhouses, day treatment programs, and psychosocial rehabilitation programs look different from each other). Subscale scores were not influenced by client characteristics (gender, race, age, diagnosis, number of hospitalizations, length of time in program). The final scale has 97 items and takes about 25 minutes to complete. The PES succeeds in measuring different aspects of programs as clients perceive them. In the programs we visited, directors felt the PES covers the important things they want to know about how clients perceive their program. The PES should become a useful tool both for researchers interested in how client responses to programs may influence their therapeutic outcomes, and for practitioners interested in improving their clients' program experiences and/or increasing convergence of staff and client views of their program.

The authors argue that it is important for developing countries to invest in adolescents, both to prevent the negative consequences of potential risky behavior and to promote healthy growth, modern skills, and the capacity to participate in the society of the future. The authors also argue that the most effective way to make such investments is to think and act holistically and from a preventive and developmental outlook.

Homelessness is a consequence of severe poverty and lack of adequate housing and is influenced by problems of mental illness and substance abuse. In this article, the authors describe the characteristics of homeless people with experiences of either mental hospitalisation or substance abuse treatment. The data come from 1,704 in-person interviews conducted in March 1987 with a three-stage random sample of homeless adult users of soup kitchens and shelters in U.S. cities that had populations of 100,000 or more in 1984. This subpopulation of homeless people differs from other homeless populations. They show more of a tendency to be male, non-minority, older, less educated, and single. In addition, they have been homeless and jobless for a longer time. They are more likely to participate in criminal activity and to experience health problems, depression, and demoralization. A major implication is that services for homeless people must be developed to reflect the specific characteristics and needs of the subpopulations among homeless people, particularly those with histories of mental health and chemical dependency treatment.

INTRODUCTION The past two years have witnessed a major shift in public commitment to end chronic homelessness within the next decade. This Article examines the phenomenon of chronic homelessness and its emergence as the focus of a significant policy transformation. It first sets the scene with a brief review of why homelessness remains a significant social problem after twenty years of public and private investment in homeless assistance networks. It then looks at definitions of homelessness in general, and chronic homelessness in particular. With respect to policy, it traces a story that starts with research. Initial research showed that even the most chronic, disabled, street-dwelling homeless people will accept and remain in housing, given the right configuration and the right supportive services. Research on program effectiveness was followed by analyses showing near break-even public costs for providing the housing. The story continues with evidence that the numbers of chronically homeless people who would need housing are within a manageable range. The Article concludes by examining what advocates have done and are still doing with the research evidence, and an overview of public commitments and the effort it will take to assure that they are fulfilled. I. CAUSES OF HOMELESSNESS Two types of factors are generally acknowledged as causing homelessness in the sense that they create the conditions under which people are more or less likely to find themselves homeless. (1) Factors of the first type are structural--they are larger societal trends and changes that affect broad segments of a population. (2) These include changes in housing markets and land use, employment opportunities, the quality and relevance of public education, institutional supports for people with disabilities, and discriminatory policies of several varieties. (3) If housing prices go up, all other things being equal, fewer people can afford housing. (4) If unemployment rises, or if pay levels of the most available jobs remain too low relative to the price of housing, fewer people can afford housing. (5) If public education and other institutions do not prepare most people to obtain jobs that pay a living wage, more people will be at risk of homelessness. (6) And so on. Structural factors determine why levels of homelessness rise or fall in this place, at this time, rather than in some other place or at some other time. (7) Factors of the second type are individual--they are the conditions and circumstances that make particular people particularly vulnerable to homelessness. (8) These include various disabilities (for example, mental illness, developmental disabilities, and physical disabilities), illnesses, illiteracy, and addictions. (9) They may also include personal circumstances such as domestic violence, too many to support on one income, having no family to rely on (for example, because one has been in foster care, or because of familial abuse), apartment condemnation, or fire, flood, hurricane, or war. (10) A third factor, public policies, may mitigate structural and individual factors that determine the ultimate level of homelessness in a particular time and place. (11) Emergency relief often can provide this for victims of natural disasters or war. A guarantee of housing may afford this for citizens of several European countries. Income and other support for people with disabilities severe enough to prevent their working might prevent their becoming homeless. (12) There will always be some people without roofs, communities, or families. The sheer number of people experiencing literal homelessness in the United States during the past two decades, however, indicates a very unfortunate convergence of structural and individual factors that, to date, have not been countered with public policies adequate to reduce their ability to generate homelessness. The campaign to end chronic homelessness during the coming decades will arise from recognizing that public policy changes could make a substantial difference. …

Even in a booming economy, at least 2.3 million adults and children, or nearly 1 percent of the U.S. population, are likely to experience a spell of homelessness at least once during a year. This likelihood grows to 6.3 percent if one considers only people living in poverty, according to the newest national analysis of homelessness by Urban Institute researchers, Martha Burt and Laudan Aron. At the same time, there is a bigger and more diverse network of homeless services than in 1987, when the Urban Institute released earlier national estimates of the homeless population.

The Kaiser Commission on Medicaid and the Uninsured commissioned this report to learn more about the role that Medicaid plays in the ability of homeless people to get health care. This report examines the ability of homeless people to get the health care they need, and the factors that affect their receipt of care. Within the general rubric of health care we include treatment for physical health, mental health, and substance abuse problems.

This report documents the characteristics of transitional housing programs for homeless families in five cities and their surrounding counties--Cleveland, Detroit, Houston, San Diego, and Seattle. It looks at housing and service configurations, entry criteria and program rules, client characteristics, outcomes, and performance documentation. Data were collected as the first stage in a project that is following families as they leave transitional housing programs and looking at the factors that influence their ability to find and keep housing, and avoid additional homelessness.

(1994). Comment on Dennis P. Culhane et al.’s “public shelter admission rates in Philadelphia and New York City: The implications of turnover for sheltered population counts”. Housing Policy Debate: Vol. 5, No. 2, pp. 141-152.

Public policy often has been blind to adolescents, except when it has focused on aspects of their behavior that trouble their elders. Too often, policy makers limit their attention to artificially narrow and isolated aspects of youth behavior. They consider only health, or only criminal, or only educational issues. In addition, the payoff of youth vulnerability and our failure to ameliorate it are rarely addressed. The few existing treatments of the cost of adolescent risk behaviors have likewise focused on single behaviors (e.g., teen childbearing— Burt 1985 Burt M.R. Teenage pregnancy. Center for Policy Options, Washington, DC1985 Google Scholar , Burt 1986 Burt M.R. Estimating the public costs of teenage childbearing. Family Planning Perspectives. 1986; 18: 221-226 Crossref PubMed Scopus (31) Google Scholar ; Burt and Levy 1987 Burt M.R. Levy F. Estimates of public costs for teenage childbearing A review of recent studies and estimates of 1985 public costs. in: Hofferth S.L. Hayes C. Risking the future: Adolescent sexuality, pregnancy and childbearing. Vol. II. National Academy Press, Washington, DC1987: 264-294 Google Scholar ) or narrowly defined patterns (e.g., being a career criminal— Cohen 1998 Cohen M.A. The monetary value of saving a high risk youth. Journal of Quantitative Criminology. 1998; 14: 5-33 Crossref Scopus (352) Google Scholar ). A just-released report identifying important future research issues related to youth ( Millstein et al 2000 Millstein S.G. Ozer E.J. Ozer E.M. Brindis C.D. Knopf D.K. Irwin Jr, C.E. Research priorities in adolescent health. University of California, National Adolescent Health Information Center, San Francisco2000 Google Scholar ) does not even mention cost, either as the cost of outcomes to society or the cost of interventions or approaches to produce better outcomes. The absence of cost concerns is even more striking as Millstein and her colleagues review and summarize a decade of published documents that in their turn summarize and integrate research on adolescence and make recommendations for future research.

Preface Introduction Summary Descriptions of Sites Using Data to Document Prevention Effectiveness Key Elements of Prevention Strategies Policy, Practice, and Research Implications Index.

This chapter discusses legitimacy as a determinant of social influence. It reviews several theories that treat the origins of endorsement accorded a formal leader and that hypothesize consequences of endorsement for social influence. When these theoretical expectations are compared with empirical findings, several interesting discrepancies emerge, and these in turn lead to a reformulation of endorsement's role in social influence processes. The chapter considers normativity as a base of influence. It presents a conceptual framework describing the dimensions of normativity that affect compliance, and also reviews existing empirical literature. The resulting portrait of normativity includes some unanticipated features that explore the differences between normativity and endorsement. In general, empirical evidence substantiates the hypothesis that high-status (HSs) earn endorsement via competence and equitableness. Empirical research demonstrates the effects of consensus on low-status compliance to HS's directives. Several studies have shown that consensus heightens compliance, while dissensus encourages deviance and renitence.

Homelessness has now been a fixture on the political scene in the United States for three decades. The scope of the problem has not been debated for more than a decade, thanks to regular nationwide counts and prevalence estimates. Progress is being made on reducing and ending homelessness, using several approaches that have been evolving since 2000, some more recently than others, amid continuing debate. This article examines definitions of homelessness in the United States and how useful estimates of population size and dynamics have been established since 2007. It then provides basic descriptive information about homelessness in the United States, looks at its patterns and antecedents, describes the growth of homeless-specific service programs, and reviews research on the costs of homelessness. It ends with probable future directions for homeless research and policy.

Recent literature shows Canada receiving fewer or delayed new medicine launches in recent years versus comparator countries.

URVEYS of alcohol use have been conducted among U.S. Navy personnel (1), U.S. Army personnel (2) and U.S. Air Force personnel (3). Several h usehold prevalence surveys have been conducted among the U.S. civilian population, most recently in 1979 (4). In this paper I provide highlights of a 1980 survey of nonmedical use of alcohol among U.S. military personnel, focusing on the prevalence and consequences of alcohol use among the active-duty military population. The data on nonmedical use of other drugs are reported separately (5). More detailed findings are presented in a complete report (6).

This interim evaluation report describes the first year of the Veterans Homelessness Prevention Demonstration (VHPD). Funded in FY2009, the VHPD is a joint effort of the U.S. Departments of Housing and Urban Development (HUD), Veterans Affairs (VA), and Labor (DOL) to provide homelessness prevention and rapid rehousing to veterans, especially those returning from conflicts in Afghanistan and Iraq. The VHPD has five sites, with each associated with a military base and a Veterans Affairs Medical Center (VAMC). The sites are in Utica, NY; Tampa Bay, FL; Tacoma, WA; San Diego, CA; and Austin, Texas. It is the first attempt to investigate homelessness prevention and rapid rehousing services for veterans and their families.Prevention and rapid rehousing are necessary components in any plan to end homelessness. Veterans are at greater risk of homelessness than comparable non-veterans, with veterans of recent conflicts possibly at higher risk than veterans of earlier conflicts. Further, compared to earlier generations of veterans, service members returning from post­-9/11 conflicts include more women, parents, and members of the National Guard and Reserve units. Because of this, Congress intended that the VHPD evaluation investigate ways to reach and serve veterans at risk of homelessness among these subgroups.

The Affordable Care Act of 2009 (P.L. 111-148) codified into law a strong emphasis on care coordination as an important strategy for improving the performance of the U.S. health care system. This article examines new structures for coordinating care for people with complex, co-occurring health conditions. Within that large group, the article focuses on people who are now or recently were homeless and the importance of including housing as part of coordinating their care. “Care coordination” is used as shorthand for a continuum of strategies and structures being developed to reach the three goals of better health care experience, better health outcomes, and cost savings. Six models are described, ranging from simple in structure—a partnership of one permanent supportive housing program and one community health center—to complex, including a limited liability, for-profit care coordination entity serving Cook County and two county-run programs (in Hennepin County, Minnesota, and Los Angeles County, California). All are works in progress, but show promise of improving care for difficult-to-serve populations.

Abstract This comment discusses several implications of the shelter use patterns revealed in the article by Culhane and his colleagues. It takes issue with the premise that reducing shelter use by families will necessarily mean that fewer of them are or will become homeless. It discusses the limited evidence of the need for transitional and permanent supportive housing options for families and offers an alternative to eliminating transitional housing completely—a blended model of supportive housing that expects many families to move on but offers permanency for those that cannot. Finally, it discusses the difficulties of putting the authors’ recommendations into practice, since they would require a good deal of centralized control and major changes in homeless and mainstream systems of care. Few communities would have the commitment and the resources in the form of mainstream and homeless assistance agencies to approximate the type of system being suggested.

This study assesses the effects of cutbacks in social welfare spending on three populations: abused, neglected, and dependent children; the chronically mentally ill; and low-income elderly. The authors trace the impacts of federal changes through state and local levels to the service agencies and the needy themselves.

Cet article retrace l’évolution aux USA, depuis les années 80, des politiques publiques et des mouvements militants en faveur des sans-domicile, ainsi que de la recherche à leur sujet. Les premières estimations, en 1984, du nombre des sans-domicile une nuit donnée suscitèrent des controverses animées. On est ensuite passé à une meilleure connaissance de leurs caractéristiques, puis au nombre de personnes touchées au cours d’une période, ce qui révèle l’importance de la population concernée. Le suivi de personnes sans abri met en évidence la complexité de leurs trajectoires et les difficultés pour quitter durablement la rue. Les mouvements militants apparurent à la suite de la récession de 1981-1982, alors que les services d’aide n’arrivaient plus à satisfaire les demandes. Le premier programme fédéral consacré directement aux sans-abri fut créé par le Congrès en 1983. Le Congrès vota en 1987 le Mc Kinney Homeless Assistance Act, qui augmenta considérablement les ressources allouées au niveau fédéral en faveur des sans-abri. Mais les coupes récentes dans le budget des politiques sociales fédérales et locales font craindre un accroissement du nombre de sansdomicile.

This article examines the sources of support for services for the homeless. It delineates the extensive role of the private sector in both funding and actually delivering shelter, meal, and other services for the homeless. It also indicates the extent to which certain states are providing financial support for homeless services, and the relation of new federal efforts through programs funded by the Stewart B. McKinney Homeless Assistance Act to state and private activities.

This paper summarizes the latest and/or most comprehensive data on important characteristics of homeless people. It looks at the demographics and distribution of homeless people among communities of different types, as documented by a range of research methodologies in various jurisdictions and nationwide. It also examines how characteristics may differ depending on the locations in which a study looked for people to include, and factors that seem to make people vulnerable to homelessness. The paper then turns to the need of local jurisdictions for information to help with service planning. It discusses the variety of people and agencies that might need information for planning, the types of decisions they must make, and what types of information would help them the most. It continues with a review of several strategies that work at the local level for collecting the most useful data, and the advantages and disadvantages of each method. Finally it draws the conclusion that every jurisdiction will be best served by gathering its own information about service needs for planning purposes. Lessons for Practitioners, Policy Makers, and Researchers The best national and local studies of homeless populations show highly variable results for most demographic characteristics, including gender, age, race, ethnicity, household structure, and length of homelessness. No national data source will ever exist that can provide adequate information for local planning. Each jurisdiction should gather its own data on population characteristics and service needs. Local data are the only data that are truly useful for local planning. Feasible and reasonably-priced ways exist for local jurisdictions to collect their own data. More and more jurisdictions are doing so. Having your own data eliminates local arguments about the existence of the problem and focuses attention on what to do about it. What you learn about the characteristics and need of your jurisdiction's homeless population will depend on where you go for information. If you go only to shelters you will miss a lot, even if you have a shelter tracking database that provides unduplicated data over time.

MF01/PC01 Plus Postage. *Adolescents; Agency Cooperation; Case Records; Community Relations; Cooperative Planning; *Cost Effectiveness; *Early Parenthood; *Federal Programs; Participant Characteristics; *Pregnancy; Program Costs; Program Development; Program Effectiveness; Program Evaluation; *Program Implementation; Rural Urban Differences; Secondary Education; Site Selection Case Management; Service Delivery Assessment

This manual is useful for all who need to understand, use, or produce estimates of the numbers and types of homeless people within their areas of responsibility. Among those who will find this manual useful are housing and welfare officials, mental health professionals, nonprofit organizations, service coordinators for the homeless, state and local legislators, and state and local service planners. It describes methods for learning about the homeless population and details the advantages and disadvantages of the various methods. Topics discussed include defining the homeless, choosing data for different uses, using caution with data sources, getting unduplicated data, using volunteers, and gaining interagency cooperation.