Gender differences in response to homelessness services

Abstract

This study examines the importance of considering gender in evaluating the effectiveness of homelessness service interventions among solitary adults with severe mental illnesses. The participants received services in one of two types of evidenced-based homelessness intervention programs: a comprehensive housing program or a specialized case management program. Using a quasi-experimental research design with non-random assignment to conditions, we examined changes in housing status, mental health, substance use, quality of life, and physical health from baseline to 6 and 12 months afterward. One hundred and fifty-two participants completed the baseline interview and 108 were available for at least one of the follow-up interviews. The results indicated that males had significantly greater reductions in homelessness in the comprehensive housing program than in the specialized case management program, whereas females showed a more complex pattern. Women in both programs showed significant reductions in homelessness, but females in the specialized case management program achieved greater stable housing time because women in the comprehensive housing program were more likely to have their time in stable housing reduced by stays in psychiatric hospitals. We conclude that variables such as gender that have been shown to influence the etiology, nature, and course of homelessness should also be considered in evaluating the effectiveness of homeless services interventions.

Introduction

Research on homelessness has increased dramatically over the past two decades. One result is a better understanding of movement into and out of homelessness, and the value of homelessness service programs. Studies have shown that a number of service programs are effective in improving the housing status of homeless people with severe mental illnesses including comprehensive housing and specialized case management programs (Dickey, 2000, Rosenheck, 2000, Shern et al., 1997, Shern et al., 2000). Comprehensive housing programs combine guaranteed access to housing; the provision of housing support services; linkages for psychiatric, substance abuse, and other psychosocial services; and assistance in obtaining entitlements and other basic services (Clark, Teague, & Henry, 1999). Specialized case management programs provide active outreach and recruitment, the provision of medication and some counselling, assistance in obtaining housing including housing vouchers, entitlement assistance, and linkages to psychiatric and psychosocial services (cf., Johnson et al., 1999, Morse et al., 1996).

Research to date indicates that formerly homeless individuals can maintain residential stability, although little is known about the factors most important in achieving such stability (Dickey et al., 1996). In response to the needs of the field, services researchers are now beginning to ‘deconstruct’ effective programs. Rosenheck (2000) has outlined the separate cost effectiveness of various program components. Others are determining which services or types of services are more effective for whom. In a study of the effectiveness of supported housing for homeless individuals with mental illness, Hurlburt, Hough, and Wood (1996) compared types and levels of case management to each other and to receiving Section 8 housing certificates. Those who received the housing certificates were almost five times more likely than people in the case management programs to achieve stability in housing. In addition, certain client variables were related to positive housing outcomes. These included being female, having less total time homeless, and having fewer drug and alcohol problems.

Clark and Rich (2003) found that psychiatric and drug and alcohol impairment moderated the effectiveness of comprehensive housing and specialized case management interventions. Persons with low- and moderate-impairment did equally well in terms of improving housing status with either type of program. However, individuals that were highly impaired did significantly better in the comprehensive housing program than in the specialized case management program.