Top

Published in:

07-09-2022

Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets

Authors: Nick Kerman, Ri Wang, Tim Aubry, Jino Distasio, Stephen Gaetz, Stephen W. Hwang, Eric Latimer, Bill O’Grady, Kaitlin Schwan, Julian M. Somers, Vicky Stergiopoulos, Sean A. Kidd

Published in: Journal of Urban Health | Issue 5/2022

Abstract

Emergency shelters are a core component of homeless service systems that address immediate basic needs. Service bans, which refer to temporary or permanent disallowances from a program or organization, are an underresearched phenomenon that can leave people experiencing homelessness without needed supports. This exploratory study examined the factors associated with shelter bans among people experiencing homelessness using secondary data from two Canadian studies: (1) a multisite randomized controlled trial of Housing First (At Home/Chez Soi Demonstration Project) and (2) a cross-sectional survey of youth experiencing homelessness across Canada (2019 Without a Home–National Youth Homelessness Survey). The two datasets were analyzed separately using logistic regression models with similar predictors to maximize the comparability of the results. Participants who experienced homelessness at an earlier age and had recent criminal justice system involvement were more likely to have shelter bans in both datasets. Impaired impulse control, more chronic medical conditions and living in Toronto were associated with increased likelihood of shelter bans in the At Home/Chez Soi dataset, whereas more adverse childhood experiences, physical violence victimization, engagement in survival sex behaviours and longer current episodes of homelessness were significant predictors of bans in the Without A Home dataset. Overall, the findings suggest that victimization and criminalization during homelessness may increase the risk of shelter loss from bans and further exclusion. The observed regional differences also highlight the potential limits of individual-level predictors. Further research is needed on shelter ban outcomes, as well as how capacity limits and organizational policies affect banning decisions.

Duchesne A, Cooper I, Baker N. The national shelter study: emergency shelter use in Canada 2005–2016. Ottawa, ON: Employment and Social Development Canada; 2021. https://publications.gc.ca/collections/collection_2021/edsc-esdc/Em12-17-2020-eng.pdf. Accessed 13 May 2021.

DeWard SL, Moe AM. “Like a prison!”: homeless women’s narratives of surviving shelter. J Sociol Soc Welf. 2010;37(1):115–35.

Kerman N, Gran-Ruaz SM, Lawrence M, Sylvestre J. Perceptions of service use among currently and formerly homeless adults with mental health problems. Community Ment Health J. 2019;55(5):777–83. https://doi.org/10.1007/s10597-019-00382-z.CrossRefPubMed

Kidd SA. Street youth: coping and interventions. Child Adolesc Social Work J. 2003;20(4):235–61. https://doi.org/10.1023/a:1024552808179.CrossRef

Skosireva A, O’Campo P, Zerger S, Chambers C, Gapka S, Stergiopoulos V. Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings. BMC Health Serv Res. 2014;14:376. https://doi.org/10.1186/1472-6963-14-376.CrossRefPubMedPubMedCentral

Abramovich A. Understanding how policy and culture create oppressive conditions for LGBTQ2S youth in the shelter system. J Homosex. 2017;64(11):1484–501. https://doi.org/10.1080/00918369.2016.1244449.CrossRefPubMed

Brown M, Mihelicova M, Lyons J, et al. Waiting for shelter: perspectives on a homeless shelter’s procedures. J Commu Psychol. 2017;45(7):846–58. https://doi.org/10.1002/jcop.21896.CrossRef

Donley AM, Wright JD. Safer outside: a qualitative exploration of homeless people’s resistance to homeless shelters. J Forensic Psychol Pract. 2012;12(4):288–306. https://doi.org/10.1080/15228932.2012.695645.CrossRef

Hoffman L, Coffey B. Dignity and indignation: how people experiencing homelessness view services and providers. Soc Sci J. 2008;45(2):207–22. https://doi.org/10.1016/j.soscij.2008.03.001.CrossRef

10.

Kerman N, Sylvestre J. Surviving versus living life: capabilities and service use among adults with mental health problems and histories of homelessness. Health Soc Care Commu. 2020;28(2):414–22. https://doi.org/10.1111/hsc.12873.CrossRef

11.

Thompson SJ, Pollio DE, Eyrich K, Bradbury E, North CS. Successfully exiting homelessness: experiences of formerly homeless mentally ill individuals. Eval Program Plann. 2004;27(4):423–31. https://doi.org/10.1016/j.evalprogplan.2004.07.005.CrossRef

12.

Wusinich C, Bond L, Nathanson A, Padgett DK. “If you’re gonna help me, help me”: barriers to housing among unsheltered homeless adults. Eval Program Plann. 2019;76:101673. https://doi.org/10.1016/j.evalprogplan.2019.101673.CrossRefPubMed

13.

Schwan K, Vaccaro M, Reid L, Ali N, Baig K. The Pan-Canadian Women’s Housing & Homelessness Survey. Toronto, ON: Canadian Observatory on Homelessness; 2021. https://womenshomelessness.ca/wp-content/uploads/EN-Pan-Canadian-Womens-Housing-Homelessness-Survey-FINAL-28-Sept-2021.pdf. Accessed 23 Mar 2022.

14.

Kerman N, Ecker J, Tiderington E, Gaetz S, Kidd SA. Workplace trauma and chronic stressor exposure among direct service providers working with people experiencing homelessness. J Ment Health. 2022. https://doi.org/10.1080/09638237.2021.2022629.CrossRefPubMed

15.

Evans J. Exploring the (bio)political dimensions of voluntarism and care in the city: the case of a ‘low barrier’ emergency shelter. Health Place. 2011;17(1):24–32. https://doi.org/10.1016/j.healthplace.2010.05.001.CrossRefPubMed

16.

Hartnett HP, Harding S. Geography and shelter: implications for community practice with people experiencing homelessness. J Progress Hum Serv. 2005;16(2):25–46.

17.

Kerman N, Lem M, Witte M, Kim C, Rhoades H. A multilevel intervention framework for supporting people experiencing homelessness with pets. Animals. 2020;10(10):1869. https://doi.org/10.3390/ani10101869.CrossRefPubMedCentral

18.

Bardwell G, Boyd J, Kerr T, McNeil R. Negotiating space & drug use in emergency shelters with peer witness injection programs within the context of an overdose crisis: a qualitative study. Health Place. 2018;53:86–93. https://doi.org/10.1016/j.healthplace.2018.07.011.CrossRefPubMedPubMedCentral

19.

Nettleton S, Neale J, Stevenson C. Sleeping at the margins: a qualitative study of homeless drug users who stay in emergency hostels and shelters. Crit Public Health. 2012;22:319–28. https://doi.org/10.1080/09581596.2012.657611.CrossRef

20.

Walsh C, Graham J, Shier M. Toward a common goal for shelter service. Soc Dev Issues. 2009;31:57–69.

21.

Canavan R, Barry MM, Matanov A, Barros H, Gabor E, Greacen T, et al. Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv Res. 2012;12:222. https://doi.org/10.1186/1472-6963-12-222.CrossRefPubMedPubMedCentral

22.

Gallardo KR, Santa Maria D, Narendorf S, Markham CM, Swartz MD, Batiste CM. Access to healthcare among youth experiencing homelessness: perspectives from healthcare and social service providers. Child Youth Serv Rev. 2020;115:105094. https://doi.org/10.1016/j.childyouth.2020.105094.CrossRef

23.

Ha Y, Narendorf SC, Maria DS, Bezette-Flores N. Barriers and facilitators to shelter utilization among homeless young adults. Eval Program Plann. 2015;53:25–33. https://doi.org/10.1016/j.evalprogplan.2015.07.001.CrossRefPubMed

24.

Kidd SA, Gaetz S, O’Grady B, Schwan K, Zhao H, Lopes K, et al. The second national Canadian homeless youth survey: mental health and addiction findings. Can J Psychiatry. 2021;66(10):897–905. https://doi.org/10.1177/0706743721990310.CrossRefPubMedPubMedCentral

25.

Rosenheck R, Lam JA. Homeless mentally ill clients’ and providers’ perceptions of service needs and clients’ use of services. Psychiatr Serv. 1997;48(3):381–6. https://doi.org/10.1176/ps.48.3.381.CrossRefPubMed

26.

Goering PN, Streiner DL, Adair C, Aubry T, Barker J, Distasio J, et al. The at home/chez soi trial protocol: a pragmatic, multi-site, randomized controlled trial of a housing first intervention for homeless individuals with mental illness in five Canadian cities. BMJ Open. 2011;1:e000323. https://doi.org/10.1136/bmjopen-2011-000323.CrossRefPubMedPubMedCentral

27.

Sheehan DV, Lecrubier Y, Sheehan KH, Amorim P, Janavs J, Weiller E, et al. The Mini-International Neuropsychiatric Interview (MINI): the development and validation of a structured diagnostic psychiatric interview for DSM-IV and ICD-10. J Clin Psychiatry. 1998;59(20):22–33.PubMed

28.

Barker S, Barron N, McFarland BH, Bigelow DA. A community ability scale for chronically mentally ill consumers. Commu Ment Health J. 1994;30(5):459–72. https://doi.org/10.1007/bf02189063.CrossRef

29.

Aubry T, Goering P, Veldhuizen S, Adair CE, Bourque J, Distasio J, et al. A multiple-city RCT of housing first with assertive community treatment for homeless Canadians with serious mental illness. Psychiatr Serv. 2016;67(3):275–81. https://doi.org/10.1176/appi.ps.201400587.CrossRefPubMed

30.

Stergiopoulos V, Hwang SW, Gozdzik A, Nisenbaum R, Latimer E, Rabouin D, et al. Effect of scattered-site housing using rent supplements and intensive case management on housing stability among homeless adults with mental illness: a randomized trial. JAMA. 2015;313(9):905–15. https://doi.org/10.1001/jama.2015.1163.CrossRefPubMed

31.

Tsemberis S, McHugo G, Williams V, Hanrahan P, Stefancic A. Measuring homelessness and residential stability: the residential time-line follow-back inventory. J Commu Psychol. 2007;35(1):29–42. https://doi.org/10.1002/jcop.20132.CrossRef

32.

Felitti VJ, Anda RF, Nordenberg D, Williamson DF, Spitz AM, Edwards V, et al. Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. Am J Prev Med. 1998;14(4):245–58.CrossRef

33.

Mental Health Commission of Canada. At Home/Chez Soi Instrument Protocol. Calgary, AB: Mental Health Commission of Canada; 2010.

34.

Currie LB, Patterson ML, Moniruzzaman A, McCandless LC, Somers JM. Examining the relationship between health-related need and the receipt of care by participants experiencing homelessness and mental illness. BMC Health Serv Res. 2014;14:404. https://doi.org/10.1186/1472-6963-14-404.CrossRefPubMedPubMedCentral

35.

Gelberg L, Andersen RM, Leake BD. The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res. 2000;34(6):1273–302.PubMedPubMedCentral

36.

Kaltsidis G, Grenier G, Cao Z, Bertrand K, Fleury M-J. Predictors of change in housing status over 12 months among individuals using emergency shelters, temporary housing or permanent housing in Quebec. Canada Health Soc Care Commu. 2020;30(2):631–43. https://doi.org/10.1111/hsc.13168.CrossRef

37.

Kidd SA, Gaetz S, O’Grady B. The 2015 National Canadian Homeless Youth Survey: mental health and addiction findings. Can J Psychiatry. 2017;62(7):493–500. https://doi.org/10.1177/0706743717702076.CrossRefPubMedPubMedCentral

38.

Dennis ML, Feeney T, Stevens LH. Global Appraisal of Individual Needs–Short Screener (GAIN-SS): Administration and Scoring Manual for the GAIN-SS Version 2.0.1. Bloomington, IL: Chestnut Health Systems;2006. https://www.assessments.com/assessments_documentation/gain_ss/GAINSS%20Manual.pdf. Accessed 30 Dec 2020.

39.

Zimet GD, Dahlem NW, Zimet SG, Farley GK. The multidimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41. https://doi.org/10.1207/s15327752jpa5201_2.CrossRef

40.

van Ginkel JR, Linting M, Rippe RCA, van der Voort A. Rebutting existing misconceptions about multiple imputation as a method for handling missing data. J Pers Assess. 2020;102(3):297–308. https://doi.org/10.1080/00223891.2018.1530680.CrossRefPubMed

41.

Hardt J, Herke M, Leonhart R. Auxiliary variables in multiple imputation in regression with missing X: a warning against including too many in small sample research. BMC Med Res Methodol. 2012;12:184. https://doi.org/10.1186/1471-2288-12-184.CrossRefPubMedPubMedCentral

42.

Roy L, Crocker AG, Nicholls TL, Latimer EA, Ayllon AR. Criminal behavior and victimization among homeless individuals with severe mental illness: a systematic review. Psychiatr Serv. 2014;65(6):739–50. https://doi.org/10.1176/appi.ps.201200515.CrossRefPubMed

43.

Fischer SN, Shinn M, Shrout P, Tsemberis S. Homelessness, mental illness, and criminal activity: examining patterns over time. Am J Community Psychol. 2008;42(3–4):251–65. https://doi.org/10.1007/s10464-008-9210-z.CrossRefPubMed

44.

Townley G, Sand K, Kindschuh T, Brott H, Leickly E. Engaging unhoused community members in the design of an alternative first responder program aimed at reducing the criminalization of homelessness. J Community Psychol. 2021. https://doi.org/10.1002/jcop.22601.CrossRefPubMed

45.

Gaetz S, O’Grady B, Kidd S, Schwan K. Without a Home: the National Youth Homelessness Survey. Toronto, ON: Canadian Observatory on Homelessness Press; 2016. https://homelesshub.ca/sites/default/files/SOHC16_final_20Oct2016.pdf. Accessed 9 Feb 2018.

46.

Heerde JA, Hemphill SA, Scholes-Balog KE. ‘Fighting’ for survival: a systematic review of physically violent behavior perpetrated and experienced by homeless young people. Aggress Violent Behav. 2014;19(1):50–66. https://doi.org/10.1016/j.avb.2013.12.002.CrossRef

47.

Roy L, Crocker AG, Nicholls TL, Latimer E, Isaak CA. Predictors of criminal justice system trajectories of homeless adults living with mental illness. Int J Law Psychiatr. 2016;49(A):75–83. https://doi.org/10.1016/j.ijlp.2016.05.013.CrossRef

48.

Walls NE, Bell S. Correlates of engaging in survival sex among homeless youth and young adults. J Sex Res. 2011;48(5):423–36. https://doi.org/10.1080/00224499.2010.501916.CrossRefPubMed

49.

Whitbeck LB, Hoyt DR, Yoder KA, Cauce AM, Paradise M. Deviant behavior and victimization among homeless and runaway adolescents. J Interpers Violence. 2001;16(11):1175–204. https://doi.org/10.1177/088626001016011005.CrossRef

50.

Kerman N, Manoni-Millar S, Cormier L, Cahill T, Sylvestre J. “It’s not just injecting drugs”: supervised consumption sites and the social determinants of health. Drug Alcohol Depend. 2020;213:108078. https://doi.org/10.1016/j.drugalcdep.2020.108078.CrossRefPubMed

51.

Anucha U. Conceptualizing homeless exits and returns: the case for a multidimensional response to episodic homelessness. Crit Soc Work. 2005;6(1). https://doi.org/10.22329/csw.v6i1.5641

52.

Nilsson SF, Nordentoft M, Hjorthøj C. Individual-level predictors for becoming homeless and exiting homelessness: a systematic review and meta-analysis. J Urban Health. 2019;96(5):741–50. https://doi.org/10.1007/s11524-019-00377-x.CrossRefPubMedPubMedCentral

53.

Dumont DM, Brockmann B, Dickman S, Alexander N, Rich JD. Public health and the epidemic of incarceration. Annu Rev Public Health. 2012;33:325–39. https://doi.org/10.1146/annurev-publhealth-031811-124614.CrossRefPubMedPubMedCentral

54.

Henry M, de Sousa T, Tano C, Dick N, Hull R, Shea M, Morris T, Morris S. The 2021 Annual Homeless Assessment Report (AHAR) to Congress — Part 1: point-in-time estimates of sheltered homelessness. Washington, DC: The U.S. Department of Housing and Urban Development, Office of Community Planning and Development; 2022. https://www.huduser.gov/portal/sites/default/files/pdf/2021-AHAR-Part-1.pdf. Accessed 22 Jan 2022.

Title: Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets
Authors: Nick Kerman
Ri Wang
Tim Aubry
Jino Distasio
Stephen Gaetz
Stephen W. Hwang
Eric Latimer
Bill O’Grady
Kaitlin Schwan
Julian M. Somers
Vicky Stergiopoulos
Sean A. Kidd
Publication date: 07-09-2022
Publisher: Springer US
Published in: Journal of Urban Health / Issue 5/2022
Print ISSN: 1099-3460
Electronic ISSN: 1468-2869
DOI: https://doi.org/10.1007/s11524-022-00680-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Please log in to get access to this content

Other articles of this Issue 5/2022

Overdose Prevention and Housing: a Qualitative Study Examining Drug Use, Overdose Risk, and Access to Safer Supply in Permanent Supportive Housing in Vancouver, Canada

Promoting Inclusive Recruitment: a Qualitative Study of Black Adults’ Decision to Participate in Genetic Research

Patient Navigation Can Improve Breast Cancer Outcomes among African American Women in Chicago: Insights from a Modeling Study

Characteristics of Tenants Who Delayed Rent Payments during Eviction Moratoria in 2020

Risky Party and Nightclub Attendance during the COVID-19 Nightlife Shutdown in New York City

Variability in Opioid-Related Drug Overdoses, Social Distancing, and Area-Level Deprivation during the COVID-19 Pandemic: a Bayesian Spatiotemporal Analysis