BOSTON'S HOMELESS,
1986-87:
CHANGE AND
CONTINUITY
Report to the Long Island Shelter
Richard Weintraub, Director
Russell K. Schutt, Ph.D.
University of Massachusetts at Boston
Executive Summary
New guests arriving
at the Long Island Shelter for the Homeless in 1986 and 1987 were similar in
many respects to those who first came to the shelter in 1983, 1984, and 1985:
***Three out of
five were white;
***Just under half had been born in Massachusetts;
***About three in ten were veterans and half were Catholic;
***About two in five had been treated for alcohol abuse;
***About one quarter had ever been jailed.
However, there were
indications of some changes:
***The median age of the guests declined from 34 to 31;
***The percentage of guests who were women rose from 20
(in 1983-84) to 29;
***The percent who had not completed high school rose from
41 (in 1985) to 54;
***The combined prevalence of psychiatric and/or alcohol
abuse problems declined from 77 to 65 percent;
***The median weeks homeless prior to coming to the
Shelter had risen from 5 to 8.
Service desires varied in a clear pattern:
***Desires for help with particular problems varied from a
high of 86 percent for housing to about 60 percent for jobs and benefits to
about 20 percent for help with an alcohol problem or with a psychiatric
problem.
Mothers with children at the shelter were quite different
from others in several respects:
***Mothers were younger, more likely to be black, and less
educated;
***Mothers had been homeless for a shorter period of time
and had a more stable residential history.
Acknowledgements
This
report has been made possible by the conscientious work of staff at Boston's
Long Island Shelter for the Homeless; the work of Robert DiGianni and William
Dillon has been critical to collection of the data on which this report is
based. Many undergraduate and graduate
students at the University of Massachusetts at Boston have also made important
contributions.
Case
managers at the Long Island Shelter interview new guests when they first arrive
using a sophisticated instrument. The
intake form identifies many of the guests' health problems and service
interests, and the prior experiences that shape these problems and
interests. The intake form is then used
by case managers and nurses at the Shelter to aid guests more effectively; a
systematic random sample of the forms is also computerized at the University to
make possible the type of general description and analysis of guests' needs
that appears in this report.
The
first version of the intake form was developed in 1983 when the shelter first
opened. After two years, Sister Debbie
Chausse, at the time the Shelter's Director of Volunteers, sought help from the
Department of Sociology at UMass/Boston to computerize the growing number of
intake forms. I responded to Sr. Chausse's
innovative request by arranging for my graduate students in Computer
Applications in Social Analysis to spend part of the course coding the
shelter's data and entering it into our computer. The students' work was the first step in
refining the intake instrument.
Shortly
after this work began, I sought out my colleague, Professor Gerald R. Garrett,
and submitted with him a grant proposal to our BioMedical Research Support
Grant program. This proposal and a
subsequent one was funded; the grant money paid assistants to work on the
project for two years. Professor Garrett
and I also arranged for some students in a graduate class on interviewing to
conduct a limited, more intensive study of guests at the Shelter. This project enabled further instrument
development. The results of this earlier
work were reported in Schutt, 1985, Schutt and Garrett, 1985, and Schutt and
Garrett, 1986.
The
exemplary efforts of my undergraduate and graduate interns and assistants have
made possible the collection of data at the Shelter during 1986 and 1987; most
of these students also contributed to case management at the Shelter. I am particularly grateful for the efforts
of Geraldine Burns, Amy Knudsen, Leon Margelis, Kevin Mulvey, and Ruth
Terry. Fatemah Behbakht, Lisa Steriti
and Lydia Todd also assisted in data management or reporting.
Russell
K. Schutt, Ph.D.
Associate
Professor and Director, Graduate Program
in Applied Sociology
TABLE
OF CONTENTS
Introduction...................................6
Methodology....................................7
The Experience of
Homelessness.................8
Social
Background..............................9
Social
Connnections...........................10
Jobs and
Benefits.............................11
Health........................................12
Legal and Service
Contacts....................14
Explaining the Situation of the
Homeless......15
Families......................................20
Conclusions...................................21
References....................................25
Tables........................................26
Services
for the homeless in Boston expanded markedly during 1986 and 1987, but the
problem of homelessness did not abate.
Boston's census of the homeless in the fall of 1986 identified 2,863
persons spending the night in shelters, hotels, and on the streets--an increase
of 100 from 1983 and possibly still an underestimate (Flynn, 1986).
During
this same period, both emergency facilities and health-related services for the
homeless increased. Several hundred
shelter beds were created in the city, many at the Long Island Shelter, others
at the Pine Street Inn, and more at several special shelters for the mentally
ill homeless (Emergency Shelter Commission and United Community Planning
Corporation, 1986). Social service
providers ranging from the state's Departments of Mental Health and Public
Welfare to the Division of Substance Abuse and the Veterans' Administration
increased outreach efforts to the homeless.
I
have sought in this report to aid the Long Island Shelter and others who seek
to serve the homeless by using the unique dataset available at the Shelter to
identify trends in the composition of the homeless, to study intensively the
characteristics of the families that appear increasingly at the Shelter, and to
learn about the interest of shelter users in particular services. While these data statistically represent only
those persons who arrived at the Long Island Shelter for the first time from
November 1985 to July 1987, previous analyses have indicated that
this population is very similar to the homeless who use other shelters in
Boston (Schutt, 1985; Schutt and Garrett, 1986).
Methodology
Data
in this report were collected by case managers and their assistants through
intake interviews with new guests. The
intake interview schedule used during 1986 and 1987 was six pages in length and
contained questions on a range of issues pertinent to case management: family and other social ties, residential
situation, personal finances, work experience, health problems, and contacts
with service agencies. In addition, a
number of questions inquired about the respondent's interest in different
services.
Intake
interviews are conducted at the Long Island Shelter in private booths, usually
after guests have had an opportunity to secure a bed and often after
dinner. Case managers inform guests that
the interview is voluntary. Information
obtained in the interviews is reviewed by case managers, nurses, and mental
health outreach workers in order to connect guests with the most suitable
services.
For
the 1986-87 report, a systematic random sample of 20 percent of the new intake
forms was computerized. The exact
sampling fraction varied between months depending on the availability of
research assistants, but in no month was the sampling fraction less than 11
percent; in two months, the sampling fraction was 66 percent or more. Only forms for individuals 17 or older were
coded.
The
overall stability of estimates of demographic information over five years of
data collection and the comparability of this information with the results of
other studies of the homeless in Boston suggest the basic reliability of the
database. Estimates of current health
problems, perhaps the most difficult characteristics to measure among the
homeless, are also consistent with other studies. The validity of the measures of alcohol abuse
used has been established in numerous studies; however, the estimate of psychiatric
problems is based only on previous treatment or current desire for
treatment--no attempt was made in these interviews to assess psychiatric
impairment directly.
The Experience of Homelessness
Homeless
persons interviewed at the Long Island Shelter were all new to the shelter, but
they were not all newly homeless. One
quarter had been homeless for one week or less at the time they were
interviewed, one half had been homeless for two months or less; almost one out
of five reported having been homeless for over one year (table 1).
Over
one quarter of the new guests usually had been sleeping on the streets or in
shelters before coming to Long Island; one quarter had lived in unstable
situations--with friends, in institutions, in single room occupancy hotels. Just under half had had a place of their own
or had usually lived with their family in the preceding six months. Boston had been the previous place of
residence for about three in five; a total of about three quarters had
previously resided somewhere in Massachusetts.
Victimization
had been common: almost one quarter had
been assaulted or robbed. Nonetheless,
within the context of the shelter, many appear to have adapted psychologically
to homelessness: about half felt
"OK" about not having a home; two in five felt "distressed."
Financial
problems were the most common reason given for being homeless: a total of 43 percent reported financial
problems or eviction as the bases of their homelessness; another two percent
mentioned job problems. Substance abuse
was given top priority by about half as many--20 percent. Other reasons given top priority included
family problems (13 percent), transience (10 percent), and emotional problems,
mentioned by only 3 percent.
Several
of these characteristics were also measured in the 1985 intake study and thus
provide a basis for identifying changes in the experience of the homeless. Only one change is apparent: in 1985, the median weeks without a regular
place to stay prior to coming to the Shelter was five; in 1986-87, the median
had risen to eight--a 62 percent increase.
Social Background
New
guests at the Long Island Shelter tended to be young: the median age of those over 17 was 31 and
over one quarter were 25 or younger; 19 percent were over the age of 46 (table
2). All but 5 percent were U.S.
citizens, but over half had been born outside of Massachusetts. Twenty-nine percent were women and 34 percent
were black or Hispanic. Almost half were
Catholic while 14 percent reported no religious preference. The median years of education for the sample
was 11, although only 14 percent had not had any high school. Thirty percent had finished high school and
another 16 percent had attended college.
Of the total sample, 28 percent were veterans; of the men, 37 percent
were veterans.
There
are some indications of changes from earlier years in these figures. Homeless persons arriving at the Long Island
Shelter in 1986-87 were somewhat more likely to be women, slightly less likely
to be veterans, and tended to be younger and less educated than those arriving
between 1983-85. The percentage female
increased over this period from 20 to 29, the percentage who were veterans
declined from 31 to 28, and the median age declined from 34 to 31. The percentage without at least twelve years
of education rose from 41 in 1985 to 54 in 1986-87 (although it had been 48
percent in 1983-84).
Social Connections
Homeless
persons coming to the shelter tended to have few social connections. Just over one out of ten were married, while
61 percent had never been married. Eight
percent were mothers having children with them at the shelter (table 3). Forty-four percent of the guests interviewed
had children in the Boston area, but just one in five reported having any other
relatives in the Boston area and just one in five reported having any friends
in the Boston area. Most interviewees
(86%) gave the name of someone who could be contacted for them in the case of
an emergency, but two-thirds reported that they had no special person they
could depend on in times of special need.
There did not appear to have been important changes in the prevalence of
these social connections since 1985, except for an increase in the percentage
naming an emergency contact--this rose from 73 to 86 percent.
Jobs and Benefits
Only
one in ten of the new guests was working (table 4). Most had worked at some time in the past; of
these, two-thirds had not worked in a month or more and one quarter had not
worked in more than a year. Just over
one quarter of the guests had never worked more than one month in any job,
although almost one-third had worked at least one year in a job. The median length of longest employment was
six months. Almost two-thirds of those
interviewed reported that they were looking for work at that time.
Two-thirds
of the new guests were not receiving any financial benefits. Not surprisingly, many reported difficulty in
affording "things such as food, clothing, or medical care." Half reported such difficulty pretty often or
always, but over one-third only had difficulty affording things once in a while
or never.
Employment
experience had changed from previous years, while the percentage receiving
benefits had not. (Perceived difficulty
of affording things was measured for the first time in 1986-87). The average length of time since last worked
had increased, while the average length of the longest job had decreased. A slightly higher percentage reported looking
for work.
Health
Almost
two-thirds reported health problems at the time of the interview--all but 5
percent were physical health problems (the percent reporting health problems
declines to about half when calculated as a percent of the total number of
guests interviewed, rather than just as a percentage of the guests answering
the question) (table 5). About half had
been hospitalized overnight for a physical health problem during the preceding
year. For these guests, the median weeks
since hospitalization was six, but almost one-third had been hospitalized
within the preceding week.
Treatment
for a psychiatric problem was less common:
28 percent had been hospitalized for a psychiatric problem, most in a
state hospital; another 10 percent had been treated just as outpatients. Over half of those treated for psychiatric
problems had last been treated within the previous year; one-quarter had not
been treated for at least five years.
Indications
of alcohol abuse appeared among just over four of every ten guests. One-quarter drank daily, over one-third drank
at least a few times per week. Over
two-thirds of the drinkers had had their last drink within the preceding
week. Only one-quarter did not
drink. Almost four of every ten had been
treated for alcohol abuse and 30 percent thought they had "a problem with
drinking." A total of 41 percent
indicated that they either drank daily or had been treated for drinking or had
said they had a problem with drinking.
When
indications of psychiatric treatment are combined with indicators of drinking,
it appears that almost one in five of the guests could be classified as having
both psychiatric and alcohol abuse problems, while just over one in every five
could be classified as drinkers without a psychiatric history and over one in
five as having a psychiatric history without a drinking problem.
This
distribution of substance abuse and psychiatric treatment represents a change
from 1985. The percentage without an
indication of either problem rose from 23 to 35 percent, while the percentage
with indications of both problems dropped from 26 to 19 and the percentage with
indications of just one of the two problems also declined by a few
percent.
Just
under one-third reported ever using street drugs; about one-quarter of these on
a daily basis and over two in every five at least weekly (table 6). Marijuana was the drug usually used by almost
two-thirds; only two other drugs were often used: cocaine by 19 percent and opiates/heroin by
10 percent. Only one in ten had ever
been treated for drug use.
Legal and Service Contacts
Few
of the homeless reported a legal problem at the time they were interviewed--a
total of eight percent said they were on probation, parole, or pending
arraignment. However, over one-quarter
had been jailed at some time. Recent
contact with social service agencies was common, but not universal, being
reported by six out of every ten respondents (table 7).
Guests'
expressed desires for assistance varied markedly across the various areas of
concern. A large majority, 86 percent,
sought help with housing (table 8). Just
under two-thirds wanted help with finding a job and with securing
benefits. Health-related services were
less popular. Forty-three percent sought
help for a physical health problem, 22 percent were interested in help for a
drinking problem, and 19 percent expressed an interest in help with a
"mental or nervous problem."
Few were interested in help with a drug problem (7 percent) or a legal
problem (2 percent).
Explaining the Situation of the Homeless
An
overview of their characteristics and problems inevitably highlights the
heterogeneity of the homeless: the
condition of homelessness can be the outcome of numerous very different
problems and setbacks; it can occur in a variety of social groups; and it is
itself a variable condition--one that is very temporary for some and a
long-term adaptation to life for others.
And
just as no single statement can adequately describe the homeless, so no single
policy can ameliorate their problems.
For some, a job and affordable housing are all that is needed to regain
residential stability; for others, some form of health care, often provided in
a therapeutic or transitional setting is necessary. Aggressive outreach may be necessary to
connect some among the homeless with needed services, simply making services
available is sufficient in other cases.
This
section identifies the extent to which experiences and problems vary across
subgroups of the homeless, in order to aid in shaping appropriate policies for
particular groups. Relations are
examined between social background and indicators of experiences and problems;
these factors are then related to orientations to services and to the
experience of homelessness. Special
attention is given to the characteristics of mothers in homeless families. Relations that are statistically significant
(that have less than one chance in twenty of being due to chance) are presented
in tables at the end of the report.
The Experience of Homelessness
Length
of homelessness did not vary with social background characteristics other than
being a parent: those with children tend
to have been homeless for a shorter period of time (table 9). However, prior residential instability was
more common among those who were older, white, unmarried and male. Victimization was reported more frequently
among men, those not married, and those homeless longer and previously in
unstable residential situations.
Feelings of distress about not having a regular place were distributed
uniformly across social groups, but those who had no special person to turn to
in times of special need were much more likely to feel distressed.
Jobs and Benefits
Age
had a strong relation to work history (table 10). Those 40 years old or older tended to have
been out of work for a longer period of time; those under 30 were less likely
to have been employed for as long as six months on any one job; and those in
their 30s were the most likely to be looking for work. Sex also was related to work history: women were more likely than men to have
worked for at least six months, but were also more likely to have been out of
work for at least five weeks. Education
had little relationship to work history, although high school graduates tended
to have been out of work for a longer period of time than others.
Receipt
of financial benefits was more common for women, for those with children, and
for minorities (table 11). Individuals
reporting previous psychiatric treatment were also more likely to be receiving
benefits than others. When psychiatric
problems were compounded with alcohol problems the likelihood of receiving
benefits was reduced; when alcohol problems appeared in the absence of
psychiatric problems, receipt of benefits was even less likely. Those giving indications of neither
psychiatric nor alcohol problems were also not likely to be receiving benefits.
The
extent to which respondents found it difficult to afford things on a daily
basis did not vary across sociodemographic groups, although was more common
among those lacking a special person to talk to in times of need (table 12).
Health
Several
characteristics were associated with poorer physical health: older age, being divorced, having no friends,
and being unemployed (table 13).
Physical health problems were also much more likely to be reported by
those having lived previously in unstable situations and by those evincing
alcoholism or alcohol abuse.
Indications
of alcohol problems increased with age and were more common among men,
veterans, and those who were divorced (table 14). Psychiatric treatment was more common among
those who were younger and female.
Relations of alcohol abuse and psychiatric problems to the experience of
homelessness were not statistically significant--although the relation of prior
residence on the streets or in shelters to prior psychiatric treatment
approached statistical significance.
Drug use was reported more often by those under the age of forty and
among those who were male, white, and single (table 15).
Legal/Service Contacts
Contacts
with service agencies were more common among women and those who were white,
divorced, and those who had children (table 16). Service contacts were also greater among
those who had previously had a more stable residential situation and those who
had been homeless for a shorter period of time.
Likelihood of having been jailed, however, increased with length of
homelessness and for those who had previously had an unstable residential
situation (table 17). Both service
contacts and jailing were less common for those without indications of an
alcohol or psychiatric problem.
Likelihood of having been jailed in the past was also greater for drug
users.
Service Desires
Interest
in particular services varied with both social background and other
characteristics. Respondents in their
thirties were more interested in help with jobs and housing than those in other
groups (table 18). Blacks were more
interested in help with housing than whites.
Men, whites, those who had been divorced and veterans were more
interested in help with drinking than women, blacks, the always single or
currently married and nonveterans.
Those who had been divorced were also more interested in help with a
drinking problem.
Expressed
service desires were also related to experience with homelessness and with
health indicators. Those from unstable
residential situations were more interested in seeing a nurse, in psychiatric
care and in help with a drinking problem.
Those who had been homeless at least one month and a half were more
interested in seeing a nurse. Those
reporting a physical health problem were more interested in help with housing
and also much more interested in seeing a nurse than those not reporting a
health problem.
There
was no significant variation in interest in help with a job or with housing
across the categories of alcohol abuse and psychiatric treatment. However, interest in health care varied with
indicators of psychiatric and alcohol problems.
Those reporting alcohol abuse were more likely to seek help from a
nurse, unless they also reported prior psychiatric treatment--the dual
diagnosis group was less likely to express an interest in seeing a nurse than
any other of these four groups. Prior
psychiatric treatment in the absence of alcohol abuse, however, was associated
with greater interest in nursing
care. Those having been treated in the
past for a psychiatric problem were also more likely to request help with a
psychiatric problem than others, but such requests were much less common for
those who indicated alcohol abuse in addition to prior psychiatric treatment.
Drug
use was associated with requests for psychiatric help but not with requests for
help with any other type of problem.
Families
There
were 33 women whose intake records indicated they had children with them at the
shelter--this would indicate a total of about 165 families at the shelter
during the year and one-half half this data were collected.
These
women were distinct from other homeless persons in terms of both their usual
social background and in terms of their health and other problems. Women in general, but mothers in particular,
were younger (70% under 30), more likely to be black, and more likely to have
previously had their own residence or lived with family (table 19). Women in general and mothers in particular
were less likely to be employed (in fact, no mothers were employed).
Mothers
were less educated and had been homeless for a shorter period than either
single women or men. They were less
likely to have alcohol problems than others--almost half (46%) indicated
neither an alcohol problem nor previous treatment for a mental health problem,
compared to about a third of the men and women without families.
Conclusions
In
many respects, the homeless persons coming to the Long Island Shelter in 1986
and 1987 were similar to those who have used the Shelter since it opened in
1983. As in previous years, the Shelter
users are a diverse group, with a range of social backgrounds, residential experiences,
and health problems. This version of the
intake form also revealed that guests' assessments of their own situation
varied widely: only a few reported such
imminent distress that felt they could not manage that night; about half
reported that they almost always have difficulty affording things.
There
were some indications of change among new guests at the Long Island Shelter and
hence, it might be inferred, among Boston's homeless. Guests arriving at the Shelter in 1986 and
1987 were a bit younger and more often female, they were more likely to have
been homeless for an extended period and were less likely to have indications
of alcohol abuse or mental illness than those arriving at Long Island in the
previous three years. These findings
suggest in part that economic difficulty may have become an increasingly
important reason for homelessness compared to alcohol abuse and psychiatric
problems, but it should be noted that the opening of several shelters targeted
specifically for the homeless mentally ill may have diverted some guests who
otherwise would have gone to Long Island.
Alcoholics
seem to be an underserved group; the explanation for this undoubtedly is in
part the nature of the disease of alcoholism and the orientations of those who
are chronic drinkers. Nonetheless, alcoholics
not having a mental health problem were less likely to be receiving financial
benefits or to have had prior contact with a social agency and more likely to
have a physical health problem than other groups.
Victimization
(assault or robbery) is a frequent experience for the homeless--reported by
almost one quarter of the new Shelter guests.
Victimization occurs most often for single men and is more likely to be
reported by those who had been homeless longer.
The
situation of homeless families is particularly tragic; those who come to the
Long Island Shelter have often been unable to find accommodations in any
smaller family shelters. The mothers
tend to be younger and less educated than other shelter users, and none were
employed. However, the mothers were also
less likely to evince substance abuse or psychiatric problems than other
Shelter users (almost none were classified in the difficult "dual
diagnosis" group) and had been homeless for a shorter period. These characteristics suggest a need for
different policies for this group, including special efforts to restore their
more recently severed social ties and to prevent the development of the
substance abuse and psychiatric problems that may develop as a consequence of
long-term homelessness.
Desires
for help with particular social and health-related services tended to vary with
the same characteristics that were associated with the social and
health-related problems themselves.
Thus, those who were white, male, divorced and veterans were more
interested in help with a drinking problem.
Interest in help with each type of health problem varied with the
prevalence of the corresponding problem, but there was at least one important
interaction between health problems:
Individuals who appeared to have either alcohol abuse or psychiatric
problems were more likely to express an interest in seeing a nurse for help
with a physical health problem, but when alcohol abuse and psychiatric problems
occurred together, the result was less interest in nursing care. This is an important indication of the need
for more intensive efforts to identify the needs of the "dual
diagnosis" group. However, it is
important to note that interest in help with finding housing and with finding
work and benefits did not vary with indications of substance abuse or
psychiatric problems--these impairments do not seem to affect the perceived
need for the most basic necessities.
The
Long Island Shelter has enhanced many of the services it provides to guests in
recent years: the nursing clinic has
been expanded and modernized; another psychiatric nurse has been added to the
staff; AA meetings have been started at the Shelter; mental health outreach
workers refer some guests to an adjacent special shelter for the chronically
mentally ill homeless. The careful
assessment of guests' needs by Long Island's case managers are a critical step
for most of these efforts; the description of the needs of the homeless
provided in this report confirms the importance of these services.
REFERENCES
Emergency Shelter Commission and The United Community
Planning Corporation. 1986. Boston's Homeless: Taking the Next Step.
Boston: City of Boston and United Community Planning Corporation.
Flynn, Raymond L. 1986. Making Room: Comprehensive
Policy for the Homeless. Boston: City of Boston.
Schutt, Russell K. 1985. Boston's Homeless: Their
Backgrounds, Problems, and Needs. Report to the Long Island Shelter.
Boston: Department of Sociology, University of Massachusetts at Boston.
Schutt, Russell K. and Gerald R. Garrett. 1985. The
Long Island Shelter Interview Study: Validating Intake Procedures. Report to
Boston City Hospital. Boston: Department of Sociology, University of
Massachusetts at Boston.
Schutt, Russell K. and Gerald R. Garrett. 1986. Homeless
in Boston in 1985: The View from Long Island. Report to the Long Island Shelter.
Boston: Department of Sociology, University of Massachusetts at Boston.