Return to Nowhere: Chronic Homelessness in the Atlanta Continuum of Care Público

Abstract

Introduction: As of January 2022, over half a million people are currently experiencing homelessness in the United States. The experience of homelessness has been associated with worsening health conditions and includes a disproportionate number of people with marginalized identities in the United States. To assist the unhoused population in gaining stable shelter, housing, and basic needs, an abundance of programming has been implemented in the past few decades. However, few studies have directly compared outcomes between programs to evaluate associations with sustained housing stability.

 

Methods: This study applied the Theory of Fundamental Causes and the Housing First Model to the participants of Permanent Supportive Housing (PSH) and Rapid Rehousing (RRH) programs through a secondary analysis of Homelessness Management Information System data from August 2020-July 2023 to determine statistically significant associations between demographic, programmatic, and structural factors and a return to homeless within two years of program exit. Sequential logic regressions produced adjusted odds ratios (AORs) for homelessness recidivism in the overall sample, among PSH participants, and among RRH participants.

 

Results: Statistically significant differences were found in homelessness recidivism between participants in Permanent Supportive Housing (PSH) and Rapid Rehousing programs (RRH). The participants in RRH program were less likely to experience homelessness following program exit when compared to participants enrolled in PSH programs (AOR=0.58, p<.01).

 

Discussion: This study found that structural and programmatic factors had statistically significant associations with homelessness recidivism. These significant associations revealed important differences in the ways programs, prior experiences with homelessness, and aftercare can play in homelessness recidivism. The causes and effects of homelessness recidivism, including the social, structural, and programmatic determinants must be considered in future research evaluation housing programs for people experiencing homelessness.

Table of Contents

CHAPTER I: Introduction. 1

Introduction. 1

Housing Program Type Description. 3

Theoretical Framework. 4

Research Question. 8

Significance Statement. 8

Definition of Key Terms. 10

CHAPTER II: Review of the Literature. 11

Introduction. 11

The Scope of the Problem of Homelessness. 12

Historical Perceptions of Homelessness. 12

Political Response to Homelessness. 13

Summary of Immediate Health Impacts. 14

Accessibility of Affordable Housing. 15

Individual and Structural Causes of Homelessness. 17

Individual Causes of Homelessness. 17

Limitations of Individual Causes. 19

Structural Causes of Homelessness. 20

Influence of COVID-19 Policy. 23

Difficulty in Assigning Causes to Homelessness. 23

Structure, Implementation, and Evaluation of Housing Programs in the US. 25

Treatment First Program Approaches. 26

Housing First Program Approaches. 27

History of Program Funding and Program Differences. 28

Historical Evaluation of Housing Programs. 29

Current Evidence for Differences in Program Success. 31

The Coordinated Entry System.. 31

Program Implementation. 33

Theoretical Framework and Application. 34

Summary of the Current Problem.. 37

CHAPTER III: Methods. 38

Introduction. 38

Study Purpose. 38

Research Aims. 39

Human Subjects Approval 39

Population and Sample. 40

Measures. 41

Data Analysis Methodology. 45

Databases and Integration. 45

Preliminary Analyses. 45

Primary Analyses 47

CHAPTER IV: Results. 49

Introduction. 49

Study Purpose. 49

Research Aims. 49

Key Findings. 50

Preliminary Analyses. 50

Primary Analyses by Study Aim.. 61

Summary of Findings. 64

CHAPTER V: Discussion. 66

Introduction. 66

Summary of Study. 66

Discussion of Key Results. 67

Research Aim 1. 67

Research Aim 2. 68

Overall Findings. 69

Strengths. 71

Limitations. 72

Implications and Recommendations. 73

Future Directions. 74

Conclusion. 75

References. 76

Appendices. 101

Appendix A: Notice Displayed in All HMIS user agencies in the Atlanta Continuum of Care. 101

Appendix B: Georgia Homeless Management Information System Client Data Sharing Opt-Out Form.. 102

Appendix C: Emory University IRB Approval Memo and Form Responses. 103

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Urban and Regional Planning Social Work Health Sciences, Public Health
Palavra-chave	Chronic Homelessness Homelessness Evaluation Houisng Programs
Committee Chair / Thesis Advisor	Eric J. Nehl, PhD, Emory University
Committee Members	Jasmine Rockwell Heard, DrPH, MPH, Emory University Alex Edwards, MPH, Emory University

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