Direct and indirect pathways between childhood instability and adult homelessness in a low-income population

There is a homelessness crisis in the United States. Many investments have been made to reverse this crisis including building more affordable housing and providing rent subsidies, which create mechanisms to support people who are currently experiencing homelessness. However, less is known about how to invest upstream to prevent homelessness in the first place. In this paper, we explore the pathway to adult homelessness from childhood instability through potentially modifiable adolescent experiences including running away, school dropout, and abuse of drugs or alcohol. We used results from our life course survey of a Medicaid population (N = 2,348) in a large metropolitan area in Oregon to create a structural equation model that measured the relationships between these experiences and adult homelessness. The overall effect of childhood instability on adult homelessness was 0.475 (p < 0.001). The direct effect of childhood instability on homelessness was 0.313 (p < 0.001). Both running away from home and alcohol and drug abuse mediated the overall association between childhood instability and homelessness. Running away from home (0.108, p < 0.001)) accounted for 22.7% of the overall association; alcohol and drug abuse (0.051, p = 0.053) accounted for 10.7%. In contrast, dropping out of school did not mediate the overall association between childhood instability and adult homelessness. These results strongly emphasize the importance of intervening upstream to reduce childhood instability to help prevent adult homelessness. Interventions that that support adolescents who run away from home and prevent or treat adolescent substance abuse may also reduce entry to adult homelessness.