Assessment of Risk and Protective Factors for Homelessness : Preliminary Validation of the Life Needs Inventory

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Philadelphia College of Osteopathic Medicine PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2006 Assessment of Risk and Protective Factors for Homelessness :
Philadelphia College of Osteopathic Medicine PCOM Psychology Dissertations Student Dissertations, Theses and Papers 2006 Assessment of Risk and Protective Factors for Homelessness : Preliminary Validation of the Life Needs Inventory Dena L. Brown-Young Philadelphia College of Osteopathic Medicine, Follow this and additional works at: Part of the Clinical Psychology Commons Recommended Citation Brown-Young, Dena L., Assessment of Risk and Protective Factors for Homelessness : Preliminary Validation of the Life Needs Inventory (2006). PCOM Psychology Dissertations. Paper 19. This Dissertation is brought to you for free and open access by the Student Dissertations, Theses and Papers at It has been accepted for inclusion in PCOM Psychology Dissertations by an authorized administrator of For more information, please contact Philadelphia College of Osteopathic Medicine Department of Psychology ASSESSMENT OF RISK AND PROTECTIVE FACTORS FOR HOMELESSNESS: PRELIMINARY VALIDATION OF THE LIFE NEEDS INVENTORY By Dena L. Brown-Young Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Psychology May 2006 Committee Members' Signatures: Frederick Rotgers, Psy.D., ABPP, Chairperson Robert A. DiTomasso, Ph.D., ABPP David Simourd, Ph.D. Robert A. DiTomasso, Ph.D., ABPP, Chair, Department of Psychology iii Acknowledgments I am forever grateful for all those who have encouraged me through this dissertation process. I want to thank my committee chairperson, Dr. Frederick Rotgers, for his ideas, support, and assistance throughout this project. I would like to thank my committee members, who have been vital to this dissertation, Dr. Robert DiTomasso and Dr. David Simourd, for their work as expert statisticians on this project. Thank you to Dr. Virginia Salzer for her assistance during the final stages. A special thank you to the Volunteers of America Delaware Valley for providing the data on which this study was based. I wish to thank my colleague Jeff Uhl, who was instrumental in my completion of this enriching doctoral experience, as well as Dr. Andrea Bloomgarden for her encouragement, her acceptance of me, and her belief in my abilities. This dissertation project, as well as my entire doctoral experience, would not have been possible without the love and support of my incredible family, especially my husband and best friend, James, as well as my daughters Damali and Jalian. I truly appreciate every sacrifice made in an effort to ensure my success. Finally, I wish to dedicate this work to every individual who is enduring the struggle for shelter, as well as to all those who are persevering in the battle, for societal understanding of homelessness as an indisputably grave aspect of the human condition. iv Abstract The purpose of this study was to examine t he LNI ( Life N eeds I nventory), us ed by t he VOADV (Volunteers of America Delaware Valley) organization to identify risk factors, as well as protective strengths, associated with the securing of stable housing among the homeless po pulation. H omelessness is a gr owing concern in the U nited S tates (Rosenberg, Solarz, & Bailey, 1991) and individuals o r families w ho become homeless are a t r isk for many more pr oblems. Finding suitable s helter is just t he beginning, a s physical safety and mental health issues become major concerns. Violence, drugs, risky sexual behaviors, lack o f s ocial support, l imited e mployment o pportunities, financial instability, a nd mental d isorders, s uch a s de pression, a nxiety, s chizophrenia, a ntisocial personality, post traumatic st ress, as well as substance use, only add to the problems o f homelessness. All o f t hese issues, a nd more, must b e co nsidered when p lanning psychotherapeutic tr eatment for c lients living in temporary shelters o r transitional housing facilities. It is essential for the VOADV to have a valid and reliable instrument with which to assess the risk factors associated with homelessness, as well as to measure the impact of protective factors on homeless individuals, because these factors relate to the securing of stable housing. This study attempts to begin the validation process of the LNI. v Table of Contents Page List of Figures vii List of Tables. viii Chapter I. Introduction. 1 Statement of the Problem: A Need for Better Assessment.. 1 Purpose of the Study: Need for a Standardized Assessment 2 Rationale for Validation of the LNI.. 3 Homelessness in America. 4 Psychological Implications of Homelessness 5 Domestic Violence. 5 Drug Dependence and Abuse 6 HIV and STD s.. 7 Social Isolation.. 8 Depression. 9 Loneliness.. 9 Distrust.. 10 Employment Problems.. 10 Medical Care Issues.. 11 Other Financial Barriers 12 Social Support Services 14 Government Policy 14 Psychological Treatment Issues II. Methods.. 18 Research Hypotheses 18 Participants 18 Study Site.. 19 Materials Description of Measures Data Analysis 22 III. Results Descriptive Statistics Demographics 24 Risk and Protective Factors Homelessness History 33 Financial. 33 Education 34 Employment 34 Medical-physical. 35 Mental health.. 36 Life/interpersonal skills and social network Substance abuse.. 37 Criminal behavior.. 38 Family of origin and current. 38 Children and dependents.. 39 Neighborhood Risk and Protective Correlations.. 40 Homelessness Risk 44 Homelessness Protective IV. Discussion 51 Limitations Recommendations for Future Research. 53 Conclusions 54 References. 56 vi vii List of Figures Page Figure Figure Figure Figure 4 27 Figure 5 28 Figure Figure Figure Figure Figure 10 31 viii List of Tables Page Table Table Tables 1.1 and 1.2 Key..43 ix Past the beggar and the suffering walked he who asks, Why, oh God, do you not do something for these people? To which God replied, I did do something, I made you. Old Sufi Saying Statement of the Problem: A Need for Better Assessment Homeless individuals often present with a myriad of complicated social and interpersonal problems. Many times, the homeless individual may be struggling with preexisting, but undiagnosed, mental health issues. In order to serve this population effectively, via the appropriate referrals for community resources, social services, and psychological interventions, a thorough understanding both of risk and of protective factors is necessary. Currently no normative data exists to describe the psychometric properties of the Life Needs Inventory (LNI), so it cannot be said that the LNI is representative of a valid and reliable instrument. Examination of the LNI will provide support for the ability of the measurement tool to identify certain factors that may assist clients in reaching their goals, as well as those specific factors that may present challenges. The Volunteers of America Delaware Valley (VOADV) organization is dedicated to providing clients with services that are effective, as well as services that are driven by empirical research. The preliminary validation of the LNI is important because it will increase the degree of confidence in the utility of the instrument as an effective measurement device. A valid and reliable assessment instrument is needed in order to appreciate the impact of risk and protective factors as they relate to homelessness, to provide a basis for making case planning decisions, to make appropriate referrals for psychological services, to understand limitations of interventions, and to identify positive lifestyle changes in homeless clients. Because the LNI assessment is already being utilized by the VOADV, standardization will be necessary in order to justify its continued 2 use, to help guide the effectiveness of its administration, and eventually to establish normative data that may drive future research. Purpose of the Study: Need for a Standardized Assessment This examination is a first step in the validation and standardization process. The LNI requires standardization in order to establish it as a valid and reliable measure for the VOADV in obtaining information regarding client history, and in order to predict future client behavior. Tools such as the LNI can usually cover broad areas and are easy to administer in a short period of time. This fact makes their use attractive because they are cost-effective. Standardized assessments go through a precise development process in an effort to establish norms. These norms then provide information regarding the performance of a normal sample of the population and can be used to compare the performance of other individuals or groups. This is the intended process for the LNI, beginning with this preliminary research project. Some characteristics of standardized assessments are procedure uniformity, understandable administration instructions, and previously established validity and reliability (Crist, 1998). Norms are also characteristic of standardized assessments; therefore, the ultimate establishment of norms for the LNI is the purpose of this gateway project. There will be more confidence in the LNI after it has undergone stringent statistical analysis to develop norms and to establish validity and reliability. With a validated measuring tool, assessment of homeless individuals can be made more efficiently; it will also be made with more confidence that the information gleaned will be useful in effective treatment planning. The assessment of risk and protective factors for a homeless individual is important, because it uncovers possible challenges 3 with which the individual may be faced when trying to secure and maintain stable housing, as well as those factors that may increase the likelihood that the individual will be successful at reaching his or her specified goals on the service plan. More services, or more intensive services, may be recommended for an individual with a higher level of risk. Ultimately, the appropriate service plan, driven by the information obtained from the LNI, may aid an individual in his or her search for housing, and may also facilitate a decrease in an individual s rate of return to homelessness. Assessment of problems and strengths provides information that helps the VOADV better serve the homeless population. Rationale for Validation of the LNI The rationale for this research project stems from the fact that homelessness is a significant concern for the VOADV, as well as for other agencies servicing this population. There is a crucial need for a valid and reliable assessment tool that identifies risk and protective factors associated with the securing of stable housing for the homeless. With this information, effective treatment plans can be developed and appropriate referrals to other agencies, such as mental health agencies, substance abuse programs, and welfare services can be made. The goal of this study was to examine the psychometric properties of the LNI, already in use by the VOADV, and to begin to establish a set of normative data to be used in future comparisons of LNI data. Statistical procedures were used to analyze the validity and reliability of the LNI and to identify any correlations between the 13 categories of the instrument. In addition, an examination of the 145 individual items represented on the LNI provided a better understanding of those items that actually 4 constitute risk factors or protective factors. Gender and racial comparisons were made in an effort to uncover any noteworthy differences between males and females, as well as between African Americans, Latinos, and Caucasians, and also to determine if the LNI has equal application among all of these groups. It was anticipated that the information obtained from this study would positively influence the effectiveness of the VOADV to serve the homeless population. The statistical data provided by this research clarifies which, as well as how risk factors and protective factors must be considered when working therapeutically with the homeless population. Homelessness in America In the 1950 s and 1960 s, the homeless population consisted primarily of older white men. They were usually confined to specific areas and were not as visible as are the homeless today. Presently the homeless population has increased to include a younger, more heterogeneous grouping of individuals who are more highly educated, more likely to use drugs and alcohol, have more physical and mental illness, and are much more publicly visible (McCarty, Argeriou, Huebner, & Lubran, 1991). Children are frequently viewed as victims and generally invoke sympathy; however, individuals with mental illness are usually thought to be the cause of their own homelessness and often invoke blame (Steinhaus, Harley, & Rogers, 2004). Much of the homeless population today consists of women of color from urban areas. Many of these women have children, usually two or three, below the preschool age. The correlates to homelessness are many, including poverty, limited employability, social isolation, mental illness, alcoholism and drug abuse, and domestic violence. All of 5 these issues, and more, may need to be explored when working therapeutically with homeless clients. Psychological Implications of Homelessness There are several determinants that may contribute to homelessness. Mental illness may be considered one of the major concerns. Although many psychological disorders exist among individuals prior to their becoming homeless, many of these psychological disorders are not diagnosed until after these individuals become homeless. These disorders include, but are certainly not limited to depression, anxiety, schizophrenia, substance use disorders, and antisocial personality disorder. Other issues connected to homelessness are trauma associated with sexual abuse, physical abuse, and domestic violence, as well as problems with interpersonal relationships, problems with the social environment, problems with the legal system, psychological distress stemming from medical conditions, and complications as a result of a physical disability. Domestic Violence Many women and some men may find themselves homeless because of domestic violence. When treating these clients, a focus on the effects of this abuse is important. The mental health of their children is also of great concern. Childhood depression, anxiety, and behavioral problems have been reported in children who have been exposed to or who have been victims of domestic violence (Sternberg, Lamb, Greenbaum, Cicchetti, Dawud, Cortes, Krispin, & Lorey, 1993). Residential instability, school change, poor nutrition, exposure to family or neighborhood violence, and parental mental health and substance abuse problems are common stressors for the children of homeless families (Buckner, Bassuk, Weinreb, & 6 Brooks, 1999). Many of the children s physical, mental, and educational problems result from these stressors. As these problems with the children increase, the stressors placed on the parents and the families increase as well. Unfortunately, this may foster the negative cycle of domestic violence. It is interesting to note that many homeless people have had several negative incidents during childhood that may have made them vulnerable and at risk for later homelessness, but many have sizeable, overall social networks and are in regular contact with family and friends (Toro, Bellavia, Daeschler, Owens, Wall, Pasero, & Thomas, 1995). During treatment, it is important to address the individual s perceived reasons for his or her current situation of homelessness. This may be done through the use of cognitive therapy. The aim is to increase the use of social network resources, and to work on a behavioral plan that strives to prevent any future recurrences of domestic violence. Drug Dependence and Abuse A significant amount of homelessness is the result of alcoholism and drug abuse (Abel & Cummings, 1993). Alcohol and other drug abuse may be viewed either as a cause or as a consequence of homelessness. Sometimes these substances are used, preceding and also following homelessness as coping mechanisms to deal with unemployment or economic problems. Short-term detoxification remedies for alcohol and other drug abuse, without adequate employment and affordable housing, simply send the abusers back to their original coping mechanisms, drugs or alcohol, to deal with unemployment and homelessness once again (Abel & Cummings, 1993). As a result, 7 there is growing interest in the long-term effects and causes of homelessness as they relate to alcohol and other drug abuse. Alcohol and other drugs are related to liver disease, serious traumas, seizure disorders and other neurological impairments, as well as, to nutritional deficiencies (Abel & Cummings, 1993). Because health problems may increase, due to the abuse of alcohol and drugs, this may be an important area of concern in treatment. Although homeless people with substance abuse problems and mental disorders have the greatest need for support services, they are the most disadvantaged and underserved group in the homeless population (Stein & Gelberg, 1995). There are also those individuals with substance abuse problems and mental disorders who have children. Unfortunately, some mothers who are currently using drugs may have abused alcohol and other substances while they were pregnant. Thus their children are negatively affected, both biologically and environmentally, by drugs and alcohol. This area must be addressed at the beginning of psychological treatment. Harm reduction is of the utmost importance if therapy is to continue. HIV and STD s Survival sex has become a way of life for many homeless individuals. There is an exchange of sex for food, clothing, and shelter (Liverpool, McGhee, Lollis, Beckford, & Levine, 2002). This type of risky sexual behavior makes people even more vulnerable to contraction of HIV and other STD s. This activity also places individuals in more situations where they are participating in unprotected sex with multiple partners and many of these partners may be intravenous drug users. 8 Liverpool et al. (2002) concluded that homeless individuals had a strong knowledge of HIV/AIDS; however, the use of condoms was not consistent with this knowledge. Sexual behavior and attitudes continue to be risky among the adolescent population of the homeless. It is important to note, however, that nationwide polls do not reveal much difference in the sexual behavior and attitudes of adolescents who are not at risk (Liverpool et al., 2002). The prevention of HIV/AIDS among this group is based on the ability of the educator to modify the sexual behavior of these young people through the complete understanding of adolescents in cognitive and behavioral contexts (Liverpool et al., 2002). More and more adolescents are becoming homeless. They are living on the street, in group homes, or in shelters. Risky sexual and drug-abusing activities are dangerously common among these homeless adolescents (Liverpool et al. 2002). As a result of survival sex behaviors, combined with the lack of condom use, these young people are at an even greater risk for infection than the general population of adolescents. This matter of life and death is a significant issue to address in therapy not only with adolescents, but also with the adult population of homeless individuals. Social Isolation Homelessness brings with it a myriad of emotional problems. A feeling of isolation from society is a major factor. A study conducted by Shinn, Knickman, and Weitzman (1991) concluded that more than three fourths of the women in the study who were seeking shelter had already stayed with family members and had used up their social resources before turning to public assistance. Also, these women had a higher prevalence of adult and childhood disruptions in social relationships. 9 Strong social ties may be an important factor in the prevention of homelessness. The development of social skills and other interpersonal relationship skills should be a focus of
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