Specialist homelessness services client pathways: Rough sleeping clients in 2016–18
Citation
AIHW
Australian Institute of Health and Welfare (2024) Specialist homelessness services client pathways: Rough sleeping clients in 2016–18, AIHW, Australian Government, accessed 08 October 2024.
APA
Australian Institute of Health and Welfare. (2024). Specialist homelessness services client pathways: Rough sleeping clients in 2016–18. Retrieved from https://www.aihw.gov.au/reports/homelessness-services/shs-rough-sleeping-clients-in-2016-18
MLA
Specialist homelessness services client pathways: Rough sleeping clients in 2016–18. Australian Institute of Health and Welfare, 06 August 2024, https://www.aihw.gov.au/reports/homelessness-services/shs-rough-sleeping-clients-in-2016-18
Vancouver
Australian Institute of Health and Welfare. Specialist homelessness services client pathways: Rough sleeping clients in 2016–18 [Internet]. Canberra: Australian Institute of Health and Welfare, 2024 [cited 2024 Oct. 8]. Available from: https://www.aihw.gov.au/reports/homelessness-services/shs-rough-sleeping-clients-in-2016-18
Harvard
Australian Institute of Health and Welfare (AIHW) 2024, Specialist homelessness services client pathways: Rough sleeping clients in 2016–18, viewed 8 October 2024, https://www.aihw.gov.au/reports/homelessness-services/shs-rough-sleeping-clients-in-2016-18
Get citations as an Endnote file: Endnote
Introduction
Rough sleeping clients are a highly visible subset of homeless people, often with complex needs and as such are a particularly vulnerable group. Around 43,000 (or 16% of all SHS clients) SHS clients were sleeping rough at some point during their contact with SHS agencies in 2022–23 (see Clients rough sleeping).
Longitudinal analyses have been undertaken for a cohort of rough-sleeping SHS clients aged 16 and over who commenced a period of support with an SHS agency in 2016–18.
Rough sleeping clients are defined as clients who, either the week before, at the time of presenting to an SHS agency, or at the end of their support period with an SHS agency, had no shelter or who were living in non-conventional accommodation, including:
- living on the streets
- sleeping in parks
- squatting
- staying in cars or railway carriages
- living in improvised dwellings or
- living in the long grass.
See Introduction to the SHS longitudinal data for details on the longitudinal analyses.
A comparison homeless non-rough sleeping cohort was defined as clients who were homeless either the week before, at the time of presentation, or at the end of a support period with an SHS agency, but who were not rough sleeping clients in any of their support periods in 2016–18. In contrast to clients rough sleeping, clients in the comparison cohort experienced secondary homelessness, which typically involves short-term or emergency accommodation including:
- refuges
- crisis shelters
- couch surfing or no tenure
- living temporarily with friends and relatives
- insecure accommodation on a short-term basis
- emergency accommodation arranged by a specialist homelessness agency (for example, in hotels, motels and so forth).
The longitudinal SHS data for the period 2014–22 were used to examine characteristics and service use patterns of rough sleeping clients compared with the comparison cohort (the non-rough sleeping cohort) (Figure RS.1).
These analyses are limited to people receiving SHS support.
The retrospective study period for this cohort is the 24 months before the start of the defining study period (which is the 24 months from the start of their first support period in 2016–18). The prospective study period is the 24 months after the end of each client’s 24 month defining study period.
Key findings
- In 2016–18, 61% of SHS clients experiencing rough sleeping were male and 92% presented for support alone.
- Half of the rough sleeping cohort had received SHS support in the previous 2 years, and over one-third received support in the following 2 years.
- Rough sleeping clients had more periods of SHS support than homeless non-rough sleeping clients and were around twice as likely to need counselling for drug or alcohol problems, or for problem gambling.
- Rough sleeping SHS clients who were transitioning from custody or who had mental health or problematic drug or alcohol issues in the defining period were more likely to need future SHS support.
Figure RS.1: Rough sleeping cohort 2016–18, longitudinal analysis overview
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.1.
Key characteristics of the rough sleeping cohort
Half of the rough sleeping cohort received SHS support in the previous 2 years, and over one-third received support in the following 2 years.
Over half (54%) of the rough sleeping cohort had a current mental health issue in the defining period.
There were over 52,200 clients in the rough sleeping cohort in 2016–18; these clients had the following key characteristics (Figure RS.2, Table Rough1618.1, Table Rough1618.2):
- Over half (53%, 27,700) were aged 25 to 44 years and 61% were male.
- Over 14,000 clients (27%) were Indigenous Australians.
- Around 16% (8,200 clients) presented for support with children sometime in the defining study period (that is, they received SHS support sometime in 2016–18 and had one or more children with them at the time of receiving any of the periods of support). Over 92% (48,100 clients) presented for support alone at some time.
- Three quarters (73% or 38,200 clients) needed short-term accommodation in the defining period, and 65% (25,100) of those received that type of accommodation.
- Over 1 in 3 clients (17,400 clients, 33%) had one support period during the defining study period and 47% (24,400 clients) had three or more support periods.
Figure RS.2: Rough sleeping and non-rough sleeping cohorts 2016–18, client key characteristics, by study period
This interactive bar chart shows a comparison between the rough sleeping and non rough-sleeping cohorts, in terms of key characteristics and across all study periods (defining, retrospective and prospective). A radio button allows selection for the individual state/territory and Australia. For Australia, rough sleeping clients were more likely to be aged 35–44 (rough sleeping clients 28% compared with 20% non rough-sleeping clients), have had drug/alcohol issues (29% compared with 15%), had mental health issues (54% compared with 44%). They were less likely to have one support period (33% compared with 47%) and more likely to have three or more support period (47% compared with 31%). Rough sleeping clients were also more likely to receive accommodation (of any type) (52% compared with 40%).
Notes:
- Counts of clients with values of No include cases where the variable is not stated or unknown.
- Clients are counted as Indigenous or overseas-born if they are classified as such in any support period in the longitudinal data.
- Percentages are calculated using total clients within the cohort as the denominator (Rough sleeper cohort: 52,209, non-rough sleeper cohort: 104,771). For the retrospective and prospective study periods the percentages may not add to 100 as not all cohort clients are included in these periods.
- Received accommodation indicates that the client was provided either short-term or emergency accommodation, medium term/transitional housing, or long-term housing.
- Short-term clients received SHS services only during the defining study period. Historical clients received SHS services in the retrospective and defining study periods. Ongoing clients received SHS services in the defining and prospective study periods. Long-term clients, received SHS services in all three study periods.
- Reason refers to the reasons a client presented to any specialist homelessness services agency during the study period.
- The variable Ever Presented Alone refers to whether a client was ever recorded as having presented for support (that is, started a support period) alone. Unlike many other variables, this is only recorded in the SHS data at the start of support periods. Counts of clients with values of No include cases where the variable is not stated or unknown. Note: for children, there may be instances where the child physically presented with an adult to an agency, but only the child required and received SHSC services, or where the child was not correctly linked to the group when the support period was opened.
- The variable Presented with child(ren) indicates whether the client presented for support (that is, started a support period) as part of a group which contained one or more children.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.1.
Male and female rough sleeping clients
Although the majority of rough sleeping clients were male (61% of the rough sleeping 2016–18 cohort) (Table Rough1618.1), research has shown that females experiencing rough sleeping face particular challenges. In particular, females who are rough sleeping have poorer health outcomes and are at greater risk of violence and exploitation than either homeless (but not rough sleeping) females or rough sleeping males (Box et al 2022).
Female rough sleeping clients were more likely than males to have experienced family and domestic violence.
Risk ratios were created to measure the association between the sex of the client and a set of client characteristics. Relative Risk is calculated by dividing the risk of an event occurring for group 1 (males) by the risk of an event occurring for group 2 (females).
In the rough sleeping 2016–18 SHS cohort, male clients were markedly different (Table Rough1618.2) in that they were less likely to:
- present with children (relative risk 0.49),
- own a home at some time in the defining study period (relative risk 0.69),
- have experienced FDV (relative risk 0.39) compared with female rough sleeping clients.
These results suggest that one of the main differences between SHS female and male rough sleeping clients was the presence of family and domestic violence, and that some women end up sleeping rough despite having owned a home.
Male SHS clients rough sleeping (relative risk 0.89) were less likely than females to have been couch surfing during their 24-month defining study period. They were also less likely (13% less) to have used services in the past (24-month retrospective period) or future (8% less in the 24-month prospective period) compared with females rough sleeping. They were more likely to have transitioned from custody (relative risk 1.31) and to have had problematic drug or alcohol issues (1.12).
Service engagement profiles
Over 37% (19,400 clients) of the rough sleeping cohort were short-term clients receiving services only during the 24-month defining study period (Figure RS.3, Table Rough1618.1). Nearly 25% (12,900) were long-term clients, receiving support in all study periods and another 26% (13,400) were historical clients who were supported in the retrospective and defining periods.
Figure RS.3: Rough sleeping cohort 2016–18, service engagement profiles
This interactive bar chart shows service use patterns of the 2016–18 rough sleeping cohort over the 2014–22 longitudinal period. Support information was combined from the discrete study periods into four service engagement profile groups (historical, short-term, long-term and ongoing). Engagement profiles for all states and territories and Australia can be selected and displayed. Nationally, of the 52,200 clients that made up the defining period cohort, 19,400 (37%) were short-term clients who only received support during the 24-month defining study period and 12,900 (25%) were long-term clients and had received support in all three study periods.
Note: Short-term clients received SHS services only during the defining study period. Historical clients received SHS services in the retrospective and defining study periods. Ongoing clients received SHS services in the defining and prospective study periods. Long-term clients received SHS services in all three study periods.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.1.
Vulnerability pathways
Using data for the period 2014–22, client profiles were examined for the presence of vulnerabilities including mental health issues, drug and/or alcohol problems, and experience of family and domestic violence (FDV) issues within each of the three study periods – the retrospective, defining and prospective periods (Figure RS.4, Table Rough1618.1, Table Rough1618.3). For more information on the derivation of these vulnerabilities, see Methodology.
Over half (54% or 28,200 clients) of rough sleeping cohort clients had a current mental health issue in the defining period. Of these, 4,400 clients (16%) received SHS support and had mental health issues in both the retrospective and prospective periods; 7,900 clients (28%) were not SHS clients in the retrospective and prospective periods.
Around one-third (29% or 15,400) of rough sleeping cohort clients had an issue with problematic drugs/alcohol use in the defining period. Of these clients, 22% (3,400 clients) were not SHS clients in the retrospective and prospective periods; 1,600 clients (11%) received SHS support and had problematic drugs/alcohol use in both the retrospective and prospective periods.
Figure RS.4 shows vulnerability profiles for rough sleeping clients, that is, the proportions experiencing FDV, with a current mental health issue and those with problematic drugs/alcohol use.
Figure RS.4: Rough sleeping cohort 2016–18, vulnerability pathways
This interactive Sankey diagram shows the 2016–18 rough sleeping clients who experienced three vulnerabilities, clients who had experienced FDV, clients with a mental health issue and those with problems with drugs or alcohol in the defining study period and whether clients also experienced these vulnerabilities in the past and future study periods. These vulnerability pathways are shown separately, using radio buttons to select between vulnerability types. Using data for the entire longitudinal period, SHS rough sleeping clients were assessed for the presence of these vulnerabilities within each of the three study periods – the retrospective, defining and prospective periods. Vulnerability data and pathways for all states and territories and Australia can be selected and displayed. Most clients at the national level experienced the vulnerability in the defining study period and were not SHS clients in the retrospective and prospective study periods. For clients who had problematic drug/alcohol use in the defining period (15,400 clients), 14% did not have problematic use in the retrospective period and were not clients in the prospective period.
Notes:
- Percentages are calculated using total clients who experienced the selected vulnerability in the defining period as the denominator.
- The defining study period covered 24 months from the first day of their first support period during 2016–18. The retrospective period for this cohort was 24 months (that is, the 24 months before the first day of the client’s first support period in 2016–18). The prospective study period for each client ranged for the 24 months after the defining period ended.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1719.3.
SHS services needed by rough sleeping clients
The need for accommodation assistance was common among rough sleeping clients in all three time periods; around 86% to 89% of clients required some form of accommodation assistance and around 84% of clients received it. Short-term/emergency accommodation was needed by about 65% to 73% of clients across all three study periods and was received by around 78% of those clients (Figure RS.5 Table Rough1618.1, Table Rough1618.4).
Figure RS.5: Rough sleeping cohort 2016–18, select top 10 services and assistance needed and service provision status by study period
The interactive stacked horizontal bar graph shows the select top 10 services needed and the provision/referral status for the 2016–18 rough sleeping cohort (52,200 clients) who received support in each study period. Across all study periods, short term or emergency accommodation was one of the most needed services, around 77% of these clients were either provided this service or referred to another agency. Long-term housing was also needed but only provided or referred to 34% of clients. Material aid/brokerage was also a key service needed by this cohort; this service was provided/referred to 95% of clients.
Notes:
- Percentages are based on the number of clients who needed the service in each study period as the denominator.
- Any accommodation assistance refers to need or provision of any of short-term or emergency accommodation, medium term/transitional housing, long-term housing, assistance to sustain tenancy or prevent tenancy failure or eviction, assistance to prevent foreclosures or for mortgage arrears.
- The services Other basic assistance, Advice/information and Advocacy/liaison on behalf of client have not been included in the top 10 shown above.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.4.
Rough sleeping cohort compared with a non-rough sleeping cohort
Rough sleeping clients are distinct from other homeless clients in that they are much more likely to be male, present alone, and select being itinerant as a reason for seeking support.
Rough sleeping clients had more periods of SHS support than non-rough sleeping clients and were around twice as likely as other homeless non-rough sleeping clients to need counselling for drug or alcohol problems, or for problem gambling.
In 2016–18, compared with the non-rough sleeping cohort, the rough sleeping cohort were (Figure RS.2, Table Rough1618.1):
- more likely to be male (rough sleeping clients 61% compared with 39% non-rough sleeping clients)
- more likely to be aged 35 to 54 and less likely to be under 24 years of age
- less likely to be short-term clients (37% compared with 51%) and more likely to be long-term clients (25% compared with 14%)
- less likely to only have one support period in 2016–18 (33% compared with 47%) and more likely to have had three or more support periods (47% compared with 31%).
Other differences are shown in Table RS.1, which shows the relative risk for various characteristics between the rough sleeping and non-rough sleeping cohorts. Refer to the glossary entry on Relative Risk for how to interpret the results.
Rough sleeping clients were more likely to have had problematic drug/alcohol issues in the defining period and to have been involved with institutions, including custodial ones, and less likely to have experienced FDV.
Much more likely | Little or no difference | Much less likely |
---|---|---|
Had Problematic Drug/Alcohol Issues 1.93 (1.89-1.97) | Needed Medium-term Accommodation 1.13 (1.11-1.14) | Child Protection Order 0.34 (0.29-0.40) |
Transitioned from Custody 1.66 (1.60-1.73) | Ever Presented Alone 1.10 (1.10-1.10) | Presented with child(ren) 0.56 (0.55-0.57) |
Exited an Institution 1.55 (1.49-1.62) | Needed Long-term Accommodation 1.10 (1.09-1.11) | Couch Surfer 0.56 (0.55-0.57) |
Received Short-term Accommodation 1.50 (1.48-1.52) | Unemployed/Not in Labour Force 1.05 (1.05-1.05) | Owned a Home 0.58 (0.53-0.65) |
Received Accommodation 1.30 (1.29-1.32) | Received Long-term Accommodation 0.98 (0.92-1.05) | Needed FDV services 0.62 (0.60-0.63) |
Needed Short-term Accommodation 1.27 (1.26-1.28) | Ended support period in public or community housing but started elsewhere 0.98 (0.96-1.01) | Experienced FDV 0.70 (0.69-0.71) |
Had Mental Health Issues 1.24 (1.22-1.25) | Started in public or community housing and ended elsewhere 0.90 (0.87-0.92) | Received Medium-term Accommodation 0.72 (0.69-0.74) |
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.1
How did service needs differ?
Rough sleeping clients were nearly twice as likely to need counselling for drug or alcohol problems, or for problem gambling than homeless non-rough sleeping clients.
Differences in identified service need between rough sleeping and non-rough sleeping SHS client cohorts were examined using relative risk, calculated by dividing the risk of an event occurring for one group (specifically, service need for each service type separately for rough sleeping clients) by the risk of an event occurring for another group (service need for non-rough sleeping clients). Note, the relative risk for service needs is calculated from all episodes of SHS support in the defining study period (the 24 months from the client’s first support period as a rough sleeping client in 2016–18); clients in the rough sleeping cohort may therefore have accessed services while not sleeping rough.
Rough sleeping clients were nearly twice as likely to need drug or alcohol counselling (relative risk 1.99) or counselling for problem gambling (1.90) during the 2016–18 defining study period than non-rough sleeping clients (Figure RS.6; Table Rough1618.5).
Rough sleeping clients who received SHS support in the future (that is, in the 24 months after the defining study period) were 2.11 times more likely than non-rough sleeping clients (in 2016–18) to need assertive outreach and 1.61 times more likely to need drug or alcohol counselling.
Among the rough sleeping client cohort, the differences in services needed by sex were that females were more likely to need nearly all services, and much more likely to need childcare (7.81 times higher), pregnancy assistance (7.75), assistance for FDV (7.57), and child specific specialist counselling services (5.23) (Table Rough1618.7). Females were less likely than males to require support for drug/alcohol counselling (0.85), meals (0.85), counselling for problematic gambling (0.82), recreation (0.80) or laundry or shower facilities (0.80).
It is important to note that the patterns in services needed from SHS agencies may not accurately record the needs of female rough sleeping clients. For example, Box et al. (2022) found that rough sleeping females surveyed during 2010–2017 had poorer physical and mental health outcomes and greater drug and alcohol problems than males rough sleeping. In the rough sleeping 2016–18 cohort, although females rough sleeping were more likely to have needed psychological services (relative risk 1.46), mental health services (relative risk 1.17) or health/medical services (1.16) compared with males rough sleeping they were less likely to require drug or alcohol counselling (relative risk 0.85) (Table Rough1618.7). The people rough sleeping in the study of Box et al (2022) were sometimes surveyed on the streets, meaning that not all the people rough sleeping in the study of Box et al. will have accessed SHS. In addition, emergency accommodation, some couch surfing and institutionally based accommodation were included in the study and those living in regional and remote areas of Australia were not included; this may account for the discrepancy between the two sets of findings.
Figure RS.6: Relative risk of needing a SHS service type, rough sleeping and non-rough sleeping SHS client cohorts, by study period, 2016–18
The interactive risk ratio plot shows the differences in service need and reasons for seeking assistance between rough sleeping and homeless non rough-sleeping clients receiving SHS support in each study period, these associations are presented as relative risks. The top services and reasons more likely to be selected by rough sleeping cohort clients compared with non rough-sleeping clients (that is, those with the largest relative risk) have been shown in the figure. A radio button allows selection of the services or reasons for assistance for each of the study periods (defining, retrospective and prospective). Rough sleeping clients were 2 times more likely to need drug/alcohol counselling (relative risk [RR] 1.99) and 3 times more likely to select itinerant as a reason for seeking assistance (relative risk [RR] 3.35) than clients in the non rough-sleeping cohort during the 2016–18 defining study period.
Note: Relative risk is derived by comparing two groups for their likelihood (risk) of an event. It is calculated by dividing the probability of a cohort client needing a SHS service/assistance divided by the probability of a non-cohort client needing a SHS service/assistance.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.5.
How do reasons for seeking support differ?
Rough sleeping clients were more likely to have inadequate or inappropriate dwelling conditions or being itinerant as a reason for seeking support than non-rough sleeping homeless clients.
Differences in stated reasons for seeking SHS support between rough sleeping and non-rough sleeping clients were examined using relative risk (Table Rough1618.6), calculated by dividing the risk of an event occurring for one group (specifically, reasons for seeking support for rough sleeping clients) by the risk of an event occurring for another group (reasons for seeking support for homeless non-rough sleeping clients).
Clients in the rough sleeping cohort nominated more reasons for seeking support than the non-rough sleeping group (Table Rough1618.1), especially being itinerant (20% compared with 5.9%, relative risk 3.35), having problematic gambling (1.2% compared with 0.4%, relative risk 2.90) and having problematic alcohol use (11% compared with 4.3%, relative risk 2.47). Conversely, clients in the rough-sleeping cohort were much less likely to nominate domestic and family violence as a reason for seeking support (25% compared with 36%, relative risk 0.68) compared with the non-rough sleeping cohort.
Among SHS clients rough sleeping there was a marked difference in reasons for seeking support based on sex (Table Rough1618.8). Females rough sleeping were much less likely to nominate problematic gambling (relative risk 0.40), transitioning from custodial arrangements (0.44) or problematic alcohol use (0.64) as a reason. Conversely, they were more likely to nominate sexual abuse (relative risk 5.77), domestic violence (4.34), transitioning from foster care (1.65) and other non-family violence (1.65) as reasons for seeking support.
What factors are most associated with rough sleeping compared with other types of homelessness?
The relationship between client characteristics including reasons for seeking services, for rough-sleeping and non-rough sleeping homeless clients, is further explored in Figure RS.7. A descriptive regression model was used to examine whether a client was rough sleeping compared with being homeless but not rough sleeping. Information on interpreting regression models can be found in the section factors associated with SHS service use.
As well as measuring associations between client characteristics, the model also examines associations with reasons for seeking services. Interactions are also included between sex (female versus male) and all variables. A statistically significant interaction (for example, sex interacting with reason: financial difficulties) means that the relationship between one variable, for example, financial difficulties being the reason for seeking services, is statistically different for females versus males.
SHS rough sleeping clients were:
- more likely than non-rough sleeping clients to have inadequate or inappropriate dwelling conditions as a reason for seeking support (1.58), or being itinerant as a reason (1.43), or having owned a home (1.27)
- much less likely than non-rough sleeping clients to be female (relative risk is 0.55), present with child(ren) (0.72), or have experienced FDV (0.84).
Figure RS.7: Relative risk of being a rough-sleeping client compared with being a homeless but not rough sleeping client, 2016–18
The interactive risk ratio plot shows the differences in the characteristics or reasons for presenting between the rough sleeping and non rough-sleeping cohorts, these associations are presented as relative risks. Relative risks for Australia are displayed. The regression model contains client characteristics and as well as reasons for seeking support in the defining study period. The model also examines associations between reasons and sex. The figure shows that rough sleeping clients were more likely to have inadequate or inappropriate dwelling conditions as a reason for seeking support (relative risk [RR] 1.58), being itinerant as a reason (RR 1.43), or having owned a home (RR 1.27).
Much less likely than non rough-sleeping clients to be female (relative risk is 0.55) or present with child(ren) (RR 0.72).
Notes:
- Apart from overseas-born and Indigenous, all other parameters capture whether a client ever experienced that situation in the defining period (for example, homeless captures whether the client was homeless at any time during a support period in the defining study period).
- Not employed means unemployed or not in the labour force.
- Presented with child(ren) means that the client started at least one support period in the defining study period with one or more children.
- This model contains client characteristics and also the reasons for seeking support in the defining study period.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.9.
Factors associated with SHS support
The main factors associated with ongoing support were having been unemployed or not in the labour force, transitioning from custody, and having mental health or problematic drug or alcohol issues in the defining period.
Descriptive regression models were used to examine whether client characteristics or support experience in the defining period were associated with SHS support in the retrospective study period (past SHS support) or prospective study period (ongoing SHS support). Information on interpreting regression models can be found in the section Understanding factors associated with past and future support. Two models were created; a ‘client characteristic’ model (Model 1) that contained client characteristics and a ‘reasons’ model (Model 2) that supplemented these characteristics with flags for the 26 possible reasons why the client sought support during the defining study period.
Variations in state and territory specific policies and service delivery models mean that the likelihood of a client receiving services in the future varies among states and territories. Therefore, in addition to a national model, separate regression models were created for each state and territory where there was sufficient sample size (at least 3,500 clients; Table Rough1618.1). The models are descriptive, that is, they describe the client variables that are associated with past or future service use without proposing or testing specific causal pathways.
The outcome variable (receipt of SHS support) was a binary measure (yes or no) and did not distinguish between clients that needed SHS services only once in the prospective study period and clients that required frequent support.
Risk ratios were created to measure the association between the use of SHS services and a set of client characteristics (see Glossary entry on Relative Risk for how to interpret the results)
Some bias is present in this outcome measure because some clients who required services in the future may not have been able to receive them (see the section on Bias within the SHSC longitudinal data).
The National results from the client characteristic model (Model 1, Figure RS.8, Table Rough1618.10) indicate that the largest associations with receiving services in the prospective period were having been unemployed or not in the labour force (107% greater likelihood). Other significant associations include transitioning from custody (40% more likely), having mental health or problematic drug or alcohol issues (35% and 32% more likely respectively), and being Indigenous (37% greater likelihood). This is partly due to the social and economic disadvantages faced by Indigenous Australians and a higher prevalence of health risk factors (POA 2004, AIHW 2020). The association between Indigenous status and SHS support could be indirect through socioeconomic factors, however, due to the limitations of the data, we cannot estimate how much is direct and how much is indirect.
The reasons model (Model 2, Figure RS.8, Table Rough1618.10) showed similar associations as the client characteristic model (Model 1), with housing crisis (25% greater) and financial difficulties (22%) being particularly associated with ongoing SHS support among rough sleeping clients.
Figure RS.8: Relative risk for use of SHS services (rough sleeping cohort 2016–18)
The interactive risk ratio plot shows the characteristics or reasons for presenting that are associated with rough sleeping clients’ need for SHS support in the past (retrospective) or future (prospective period), these associations are presented as relative risks. Relative risks for all states and territories and Australia can be selected and displayed (where there was sufficient sample size). Two regression models can be selected, Model 1 contains client characteristics and experiences in the defining period, Model 2 contains client characteristics and the reasons for seeking support in the defining study period. For both past and future SHS support the associations were similar. Nationally, being unemployed or not in the labour force during the defining study period had the strongest association (107% greater likely) with past or future SHS support. Other significant associations include transitioning from custody (40% more likely), having mental health or problematic drug or alcohol issues (35% and 32% more likely respectively), and being Indigenous (37% greater likelihood).
For Model 2, rough sleeping clients who indicated the reasons, housing crisis (25% greater) and financial difficulties (22%) were particularly associated with ongoing SHS support.
Notes:
- Apart from overseas-born and Indigenous, all other parameters capture whether a client ever experienced that situation in the defining period (for example, homeless captures whether the client was homeless at any time during a support period in the defining study period).
- Not employed means unemployed or not in the labour force.
- Presented with child(ren) means that the client started at least one support period in the defining study period with one or more children.
- Model 1 contains client characteristics and experiences in the defining period, Model 2 contains client characteristics and also the reasons for seeking support in the defining study period.
Source: AIHW analysis of SHS longitudinal data 2014–22, Table Rough1618.10.
AIHW (2020) Health risk factors among Indigenous Australians. Australia's health 2020: snapshots. Australia’s health series no. 17 Cat. no. AUS 232. Canberra: AIHW.
AIHW (2016) A profile of Specialist Homelessness Services homeless clients 2011–12 to 2014–15. Canberra: AIHW
Box E, Flatau P, Lester L. 2022. Women sleeping rough: The health, social and economic costs of homelessness. Health and Social Care 30 (6) e4175-e4190
POA (Parliament of Australia) (2004) ‘A hand up not a hand out: Renewing the fight against poverty’. Report on Poverty and Financial Hardship. Canberra: Senate Community Affairs Reference Committee.