No abstract

The current study tested the postdictive validity of the Vulnerability Index (VI), an instrument used to assess medical vulnerability among people who are homeless. It also examined the relationship between hospitalization records and self-reported health status. The VI is based on self-reports of hospital utilization and chronic health conditions. Data were collected over a one-year period from individuals receiving homeless services in a southwestern city (N = 97, 53.3% male, 57.7% African American). Vulnerability Index scores and three subcomponents of the measure (chronic health conditions, substance use, and mental health problems) were regressed on official reports of past-year hospitalizations, controlling for gender and race, using four separate regression models. Official hospitalization records significantly predicted overall VI scores, but they did not predict the subcomponents of the measure. Results show that, within the current sample, official hospital records are predictive of overall VI scores and are correlated with self-reported hospitalization. The lack of relationship between hospital records and subcomponents of the VI may indicate an underutilization of health care for those with serious health conditions.

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The veterans and nonveterans residing in a low-demand shelter faced several barriers to escaping homelessness. Both groups made similar use of non-VA services, but veterans used more services overall because of their access to VA services. The predictive power of insurance indicated that veterans may experience barriers to care despite the availability of VA services. The presence of veterans in this low-demand shelter may represent evidence of barriers to veteran and other public housing services.

The purpose of this qualitative study was to develop an in-depth understanding of the experience of unsheltered homelessness in Fort Worth, Texas. Eighteen individuals participated in the study; 13 were full-time residents of Fort Worth and 5 were traveling through the area via freight train. All reported long-term histories of unsheltered homelessness. Interviews were conducted in naturalistic settings; for example, on the street, under bridges, and in camps. Results indicated that the participants entered homelessness through diverse paths, but all of these paths were characterized by loss and social isolation. Many described homelessness as a threatening and dangerous experience; relying on strong street-based social networks and their own personal strengths for survival. Participants viewed shelter service providers as sources of stress and stigma to be avoided but heavily utilized street outreach services and faith-based missions. The overemphasis by providers on "fixing" people, rather than addressing immediate needs, made many participants ambivalent about traditional services. This study supports the use of nontraditional housing interventions and robust community-based approaches to care for individuals experiencing unsheltered homelessness.