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Description
The purpose of this study is to identify individual-level factors that are significantly associated with effective help-seeking behavior among San Diego's street homeless population. Some persons living on the street are able to easily identify what they need and the services that might help them the most, i.e. their description of their problems/challenges matches well with the services they seek. On the other hand, some homeless persons have much more difficulty matching their problems with possible solutions. These individuals need interventions that are tailored to their understanding of themselves and their unique situations. While the issue of barriers to service access has received attention in recent years, gaps persist in the existing body of research into service utilization and help-seeking behaviors of homeless individuals. Using data from the 2009 San Diego RTFH Street Characteristics Survey, this research study aims to address this gap by identifying variables that are significantly associated with effective help-seeking behavior. The Street Characteristic Survey was designed to capture both quantitative and qualitative data from participating homeless individuals. Questions focused instead on basic demographics, military service, living situation, marital status, reasons for living in San Diego, length and description of homelessness, employment, income sources, education, health status, drug use, self-rating of health status, HIV status, service usage, perceived reasons for being homeless, services needs, service usage and if they have been a victim of violence. Between January 13, 2009 and February 26, 2009, trained volunteers collected 305 interviews from 'street' homeless persons encountered at seventeen locations located across San Diego County. In total, 302 completed surveys met all eligibility requirements for inclusion in analysis. Three surveys were excluded because the individual was not sleeping on the street the night before. An additional seventeen surveys were excluded from analysis because they were missing data necessary for analysis. A sample size of 287 surveys was included in the analysis. The outcome of interest was a composite variable created to measure the degree of concordance survey participants exhibited between their normative service needs and their perceived service needs. The relationships between five demographic factors and the concordance outcome variable were assessed for significance. The following factors were included in the analysis: history of service accessing, chronic homelessness, gender, race category, and veteran status. vi SPSS 17.0 and SAS 9.1 statistical software were used to carry out the analytic steps. After constructing the composite Concordance outcome variable, univariate and biavariate analyses were conducted. Two logit models were fitted through stepwise regression model building: one for the probability of low versus fair/high concordance between normative and perceived needs, and another for the probability of low/fair concordance versus high concordance. The results of the ordinal logistic regression revealed that only history of service use and chronic homelessness were significantly associated (at the 5% level) with the level of concordance participants' exhibited between normative and perceived needs. Those participants with some history of service use had 4.566 (95% CI 2.551-8.130) greater odds than those with no history of use of exhibiting high versus poor or fair concordance in their needs assessments. Chronically homeless participants had 3.496 (95% CI 2.057-5.952) greater odds than those who were not chronically homeless of exhibiting high versus poor or fair concordance in their needs assessments. This study adds to a very small body of research on the extent to which homeless individuals display concordance between the services they seek and those they need. The findings suggest that, in general, this population does not effectively use available resources to address their needs. At its core, the ability to meet basic needs reflects how well suited a person is to deal with the challenges of daily life. It is the task of public health professionals to equip vulnerable members of society with the skills and support needed to lead healthy and productive lives. By better understanding the individual-level factors that distinguish a person who can meet his needs from one who cannot, researchers increase the capacity of the service system to intervene and alleviate problems before they escalate into homelessness
