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discharge planning among people being released from institutions and programs to
ameliorate domestic conflicts. As noted above, a substantial minority of homeless
individuals follows institutional circuits, including mental hospitals, jails, and
shelters as well as informal housing arrangements and the street.

(A smaller

minority of both single individuals and parents in families has a history of foster
care placement.) However, Lindblom (1991) pointed out that relatively few people
go directly from institutions to the streets, and there is no evidence that substantial
numbers of youths "age out" of foster care into homelessness.

We are not aware of any experimental evaluations of the efficacy of discharge

planning programs in preventing homelessness.

Impressive gains have been

demonstrated by a New York city study of a 9-month-long "critical time interven-
tion" that offered intensive transitional support to men leaving a psychiatric pro-
gram in a shelter (Susser et al., 1997), but the duration of this intervention is
substantially longer than what is usually meant by discharge planning. Also, the
companion role of secure housing in arresting shelter recidivism was not
described. In sum, then, although discharge-planning programs make sense on log-
ical grounds, at least as part of longer term programs for people with persistent
problems, empirical studies of their ability to prevent homelessness are wanting.
We suspect that more enduring interventions or negotiated guarantees of secure
housing are necessary.

Programs to Ameliorate Domestic Conflicts

Studies frequently find high rates of childhood physical and sexual abuse, fos-

ter care and other out-of-home placements, and domestic violence in the

116

Shinn, Baumohl, and Hopper

Belcher (1997) documented the costs and problems associated with homeless mentally ill indi-

viduals who are repeat users of services and approach emergency rooms for care. For example, home-
less mentally ill people are far more likely than domiciled mentally ill people to enter the criminal
justice system and to commit violent crimes (Martell, Rosner, & Harmon, 1995; Michaels, Zoloth,
Alcabes, Braslow, & Safyer, 1992).

Sosin and Grossman's (1991) study of homeless and domiciled mentally ill individuals using

free-meal programs in Chicago is one of the few to specifically examine the association of discharge
planning with homelessness. Among people with histories of psychiatric hospitalization, there was no
difference between homeless and domiciled individuals in the percentage who had living arrangements
made for them at last discharge from the hospital, the percentage for whom arrangements involved
living with family members, or the percentage referred to outpatient treatment at discharge. Income,
rather than individual factors or experience in the mental health system, was the primary predictor of
being housed.

For studies of childhood factors, see Bassuk et al. (1997); Bassuk & Rosenberg (1988); D'Ercole

& Struening (1990); McChesney (1987); New York City Commission on the Homeless (1992); Rog,
McCombs-Thornton, Gilbert-Mongelli, Brito, & Holupka (1995); Roman & Wolfe (1995); Shinn,
Knickman, & Weitzman (1991); Sosin, Colson, & Grossman (1988); Susser, Struening, & Conover
(1987); and Wood, Valdez, Hayashi, & Shen (1990). Most studies also find higher rates of domestic
violence among homeless than among other poor families (Shinn et al., 1991; Wood et al., 1990), but
two studies with more detailed questions (Browne & Bassuk, 1997; Goodman, 1991) found no differ-
ence: Rates in both homeless and housed groups were extraordinarily high.