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
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.
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
The Experience of Homelessness.................8
Jobs and Benefits.............................11
Legal and Service Contacts....................14
Explaining the Situation of the Homeless......15
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.
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).
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.
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).
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.
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).
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).
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.
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.
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.
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.
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.