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Establishing a Competing Risk Regression Nomogram Model for Survival Data
Published on: October 23, 2020
Understanding Wait Times in Rapid Re-Housing Among Homeless Youth: A Competing Risk Survival Analysis
Hsun-Ta Hsu1, Eric Rice2, Jennifer Wilson3
1School of Social Work, University of Missouri, 709 Clark Hall, Columbia, MO, 65211, USA. tah@missouri.edu.
Abstract:
Approximately 3.5 million youth experience homelessness in the United States. Assisting youth to exit homelessness as quickly as possible through various housing venues aims to prevent adverse health impacts that prolonged homeless experiences may have on youth. Rapid re-housing (RRH) is a recent, short-term, less costly housing option than permanent supportive housing that provides temporary housing supports and services to counter homelessness. Although previous literature indicates that youth are likely to achieve stable homelessness exits via RRH, the duration of wait times for youth and potential disparities in RRH waiting periods remain unclear. We used administrative data from 16 communities across the United States (N = 10,920) to gain a greater understanding about RRH wait times among homeless youth. In addition, we adopted a competing risk survival analysis to investigate potential disparities (i.e., race and ethnicity, gender, rurality, sexual orientation, and previous homelessness condition) in RRH wait times while taking into consideration the presence of other homelessness exit options (e.g., permanent supportive housing). Study results indicate that RRH is a common homelessness exit for homeless youth and is prioritized for youth assessed as mid-vulnerability, per commonly accepted assessment measures of youth vulnerability. However, youth who received RRH waited, on average, 131 days following their housing eligibility assessment. Furthermore, being a minor (i.e., 17 years old or younger), experiencing homelessness in rural communities, and lower engagement in homeless services (e.g., emergency shelters and transitional living programs) were all associated with lower probability of exiting into RRH over time, taking into account the possibility of other competing homelessness exits. Expansion of the short-term housing supports offered through RRH may be a promising strategy to counter homelessness among youth in a timely manner. However, such an expansion should also address the potential disparities underlying youths' wait time to receive RRH in order to reduce prolonged homelessness experiences within this vulnerable population.
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