OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.

The present investigation used qualitative methods to explore the response to housing and experience of community integration of formerly homeless individuals diagnosed with severe mental illness recently housed in both independent and staffed residential settings. Findings indicate that entering into housing after a long period of homelessness is associated with improvements in community integration for most individuals diagnosed with severe mental illness. However, for a meaningful minority, the adaptation to housing may also be associated with challenges that can complicate the integration process. Implications of findings are discussed in the context of how best to tailor programs to meet the complex needs of persons diagnosed with severe mental illness and to maximize community integration.

Though surveys repeatedly demonstrate that most women who are homeless alone have minor children living apart from them, there is little information on the circumstances of their separations or whether and how they remain involved with their children. Analysis of data from in-depth interviews with mothers, relatives caring for their children, and shelter and child welfare staff highlights a tension between perspectives and aspirations of mothers and the agendas and social processes through which institutional systems manage the family life of women marginalized by homelessness and disability. Though women's agency is evident in their efforts to maintain parenting roles, without facilitating resources and supportive structures, agency is often reduced to unpalatable choices among constraining alternatives. We consider how service systems might mitigate barriers to mothering as well as broader changes needed to genuinely support women's aspirations for themselves and their families.

We studied the prevalence of biologically confirmed HIV, Chlamydia, and gonorrhea in a randomly selected sample of sheltered homeless women in New York City, and explored their association with demographic, homeless history, and clinical risk factors. 329 women were randomly selected from 28 family and single adult shelters. The estimated prevalence of HIV in the study sample is 0.6 % (±0.3 %); for Chlamydia it is 6.7 % (±2.2 %); for gonorrhea it is 0.9 % (±0.04 %). A history of childhood sexual abuse, arrest history, current psychotic symptoms, and substance use disorder placed women at greater risk of infection. We consider contextual factors that may yield underestimates of HIV prevalence in our sample and discuss how a more comprehensive prevalence estimate might be constructed. Findings underscore the importance of offering HIV/STI testing, counseling, and HIV risk prevention interventions to homeless women and suggest that interventions should be tailored to the needs of specific subgroups of homeless women.

Families that contend with the losses, disruptions, and hardships occasioned by homelessness often experience dispersal of children as well. Although a federal initiative on homeless families identified family preservation as a focus of intervention development, there is little research to guide service efforts. This qualitative study of mother-child separations in homeless families with maternal mental health and/or substance use problems identifies precursors of separations (precarious housing, turbulent relationships, substance abuse by mothers and others, institutional confinement, and children's needs) and examines how mothers' responses to these events and conditions interact with social and institutional contexts to shape variations in the course and outcome of separations. Implications for research, services, and policies affecting homeless families are discussed.When I returned to the shelter, Security was waiting for me. When I found out [that child welfare workers took my daughter], I kept asking, 'Where is my baby?' I ran back into my room and took some kind of pills. Security. . .called an ambulance that took me to the Medical Center. . .They took a part of me when they took her."Doreen," whose toddler was placed in foster care after wandering away from a shelter neighbor who was babysitting. , and the journal's anonymous reviewers provided insightful comments that improved the article. We are particularly grateful to the women who agreed to share their stories with us.