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Brief reportIntellectual disability and homelessness C. Mercier 1 & S. Picard 2 1 Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada 2 Lisette-Dupras Rehabilitation Center and CSSS Jeanne-Mance, Montreal, Canada Abstract Background The association between poverty and intellectual disability (ID) has been well docu- mented. However, little is known about persons with ID who face circumstances of extreme poverty, such as homelessness. This paper describes the situ- ation of persons with ID who were or are homeless in Montreal and are currently receiving services from a team dedicated to homeless persons. Aims (1) To describe the characteristics, history and current situation of these persons; and (2) to report within-group differences as a function of gender and current residential status. Methods The data were collected from files using an anonymous chart summary. Descriptive statistics on the whole sample (n = 68) and inferential statis- tics on cross-tabulations by gender and residential status were performed. Results Persons with ID exhibited several related problems. Some of these persons, primarily women, experienced relatively short periods of homelessness and their situations stabilised once they were identi- fied and followed up. Other persons with ID experi- enced chronic homelessness that appeared to parallel the number and severity of their other problems. When compared with a previous epide- miological study of the homeless in Montreal, the population of homeless persons with ID differed from the overall homeless population in a number of respects. Conclusion The results suggest prevention and intervention targets. The need for epidemiological research appears particularly clear in light of the fact that below-average intellectual functioning has been identified as a risk factor for homelessness and a predisposing factor for vulnerability among street people. Keywords cognitive limitations, homelessness, intellectual disability, poverty, special needs Introduction Poverty has been associated with intellectual disabil- ity (ID) as both a risk factor and a consequence (Inclusion International 2006; Emerson 2007; Chapman et al. 2008). However, little is known about persons with ID whose levels of poverty and social isolation have driven them to residential instability and homelessness. This paper presents the situations of 68 persons with ID who were or are homeless in Montreal and were in contact with an outreach team dedicated to homeless people. It Correspondence: Dr Céline Mercier, AETMIS, 2021 Union Avenue, Room 10.083, Montreal (Quebec), Canada H3A 2S9 (e-mail: [email protected]). Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2010.01366.x volume 55 part 4 pp 441449 april 2011 441 © 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd

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Page 1: Intellectual disability and homelessness

Brief reportjir_1366 441..449

Intellectual disability and homelessness

C. Mercier1 & S. Picard2

1 Department of Social and Preventive Medicine, University of Montreal, Montreal, Canada2 Lisette-Dupras Rehabilitation Center and CSSS Jeanne-Mance, Montreal, Canada

Abstract

Background The association between poverty andintellectual disability (ID) has been well docu-mented. However, little is known about personswith ID who face circumstances of extreme poverty,such as homelessness. This paper describes the situ-ation of persons with ID who were or are homelessin Montreal and are currently receiving servicesfrom a team dedicated to homeless persons.Aims (1) To describe the characteristics, historyand current situation of these persons; and (2) toreport within-group differences as a function ofgender and current residential status.Methods The data were collected from files usingan anonymous chart summary. Descriptive statisticson the whole sample (n = 68) and inferential statis-tics on cross-tabulations by gender and residentialstatus were performed.Results Persons with ID exhibited several relatedproblems. Some of these persons, primarily women,experienced relatively short periods of homelessnessand their situations stabilised once they were identi-fied and followed up. Other persons with ID experi-enced chronic homelessness that appeared to

parallel the number and severity of their otherproblems. When compared with a previous epide-miological study of the homeless in Montreal, thepopulation of homeless persons with ID differedfrom the overall homeless population in a numberof respects.Conclusion The results suggest prevention andintervention targets. The need for epidemiologicalresearch appears particularly clear in light of thefact that below-average intellectual functioning hasbeen identified as a risk factor for homelessness anda predisposing factor for vulnerability among streetpeople.

Keywords cognitive limitations, homelessness,intellectual disability, poverty, special needs

Introduction

Poverty has been associated with intellectual disabil-ity (ID) as both a risk factor and a consequence(Inclusion International 2006; Emerson 2007;Chapman et al. 2008). However, little is knownabout persons with ID whose levels of poverty andsocial isolation have driven them to residentialinstability and homelessness. This paper presentsthe situations of 68 persons with ID who were orare homeless in Montreal and were in contact withan outreach team dedicated to homeless people. It

Correspondence: Dr Céline Mercier, AETMIS, 2021 UnionAvenue, Room 10.083, Montreal (Quebec), Canada H3A 2S9

(e-mail: [email protected]).

Journal of Intellectual Disability Research doi: 10.1111/j.1365-2788.2010.01366.x

volume 55 part 4 pp 441–449 april 2011441

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describes these persons’ characteristics, historyand current situation and reports on within-groupdifferences as a function of gender and currentresidential status.

According to literature reviews by Cotman &Sandman (1997) and by Spence et al. (2004),global cognitive impairments are more prevalent inhomeless populations (3–40%) than in the generalpopulation (1–3%). Most published studies thathave investigated below-average intellectual quo-tient (IQ) as a risk factor for homelessness havefound evidence for this hypothesis (Bremner et al.1996). Mean current IQ scores reported insamples of adult homeless persons vary between97 and 74 (Foulks et al. 1990; Adams et al. 1996;Bremner et al. 1996; Cotman & Sandman 1997;Seidman et al. 1997). In Cotman & Sandman’s(1997) study, 37.5% (9 of 24) of the personsassessed scored in the borderline and ID range(below 85), compared with the 16% expected ingeneral populations. In Bremner et al.’s (1996)study, 15 of the 54 participants (28%) had IQs inthe ID range (between 55 and 70), comparedwith an estimated 1–3% in the general population(World Health Organization 2007). To our knowl-edge, Oakes & Davies (2008) were the first toassess ID using the three criteria of below-averageIQ, limitations in adaptive functioning and onsetprior to the age of 18 years (American Associationon Intellectual and Developmental Disabilities2010). In a random sample of 50 people staying inshelters for at least 6 months, they found a 12%rate of ID.

The characteristics and living circumstances ofpersons with ID living without settled accommoda-tion have gone virtually undocumented. A report bySimons (2000) in England documented the experi-ences of persons with ID not in contact with spe-cialised services. Two-thirds of the 28 studyparticipants had faced homelessness or unstablelodging. These results are similar to those ofLeedham’s (2002) exploratory study, whichdescribed past and present personal, social andsystems-related problems faced by young homelesspersons with ID. Leedham concluded that thetarget group had more personal problems than didyoung people in general, and that services systemsfailed to respond adequately to their supportneeds.

Methods

The data were provided by a specialised team affili-ated with a front-line public health and welfareagency and dedicated to facilitating homelesspersons’ access to health and social services.Theteam offers nursing, psychosocial, medical and psy-chiatric care, group therapy and outreach (morethan 7000 interventions annually). Most requests arefor non-recurring assistance (information, adminis-trative procedures, minor emergencies, occasionalhealth care). Approximately 200 persons receiveregular follow-up. Of these, 68 are followed (about550 interventions annually) by a psycho-educator(second author of this article) specialised in thesupport and rehabilitation of persons with ID.Thesepersons were referred by other public front-line ser-vices, emergency rooms and hospitals, and commu-nity organisations because of their intellectuallimitations.The main reason for referral was thatthey were defenceless in current situations of abuse,mainly financial or sexual.Twenty of these 68 clientshad been formally evaluated by a clinical psycholo-gist specialised in ID, using the DSM-IV criteria inthe context of a relevance review to ensure thatpersons receiving services corresponded to the targetgroup. For the others, classification as a person withID was based on history and current profile.Thecriteria applied were those used in community-basedepidemiological studies or in screening instrumentssuch as the Hayes Ability Screening Index (Hayes2000): education in special classes or schools; experi-ence of institutions; problems with orientation intime and space; difficulties in calculating, writing,reading.Their difficulties with adaptive behaviourcreated many problems in their daily lives, such as inmoney management, use of public transportation,meal preparation, laundry, etc.These 68 individualscomprised the study population.

The data were collected from the psycho-educator’s files. An anonymous chart summary wascompleted for each person, using an informationgrid. The research team had access only to thisgrid. The agency’s Research Ethics Board approvedthis study.

The choice of variables was a function of thevalid information available in the files. Missingvalues accounted for no more than 20% of any ofthe variables, with the exception of the type of

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current regular activity (25%). The 13 variableswere grouped into three themes: sociodemographiccharacteristics and history (gender, age, city ofbirth, education, previous institutional stay, precipi-tating factors for homelessness, duration of home-lessness); problems at intake (nature, number);current situation (residential status, family contacts,main regular activity, type of follow-up by homelessteam).

Data from the information grid were entered intoa Microsoft Excel database, transferred to spss andsubjected to descriptive (frequencies, means, per-centages) and inferential statistical analysis (chi-square and Kruskal–Wallis for ordinal variables, e.g.number of problems at intake, duration of home-lessness). For comparisons based on residentialstatus, three groups were created. The first two,street/shelters and precarious circumstances, corre-sponded to the United Nations distinction between‘absolute homelessness’ and ‘relative homelessness’(Hwang 2001; United Nations 2004). The 11 (16%)individuals in the street/shelters group (‘absolutehomelessness’) slept outdoors (in parks, automated-teller booths, vehicles, subway, abandoned build-ings) or frequented homeless shelters. Individuals(n = 42, 62%) in the precarious circumstances group(‘relative homelessness’) had a physical shelter(long-term community housing, a room or anapartment, most often in a transient mode), butremained dependent on the services for homelesspersons to meet basic needs or to access services(such as soup kitchens). The third group, stabilisedcircumstances, consisted of 15 previously homelessindividuals (22%) who at the time of data collectionlived either in a residence associated with a rehabili-tation centre for persons with ID, in communityhousing or in a private apartment, and no longerdepended on services for the homeless. Our interestbeing both to describe homelessness among personswith ID and to understand its course, we includedthis group to learn more about the characteristics ofindividuals ‘exiting’ from homelessness.

Results

Characteristics of the population

Of the 68 homeless persons considered to have anID, 43 (63%) were men and 25 (37%) women

(Table 1). Their mean age was 43 years (range:24–68). More than three-quarters of them wereborn in Montreal. As expected, 78% had attendedspecial classes or schools and almost one-third(31%) had lived in institutions. The majority (63%)had been homeless for more than 4 years at thetime of their admission to the homeless team. Morethan one-third (37%) attributed their homelessnessto a substance abuse problem. The second mostcommonly cited explanation was the loss of, orbreakdown of a relationship with a parent or lovedone (31%). At intake, all reported at least oneproblem and 22 (32%) at least three, the meannumber of problems being 2.0. The most commonproblems were mental health disorders (60%), fol-lowed closely by substance abuse (56%). Physicalhealth problems were observed in 43% of partici-pants and problems with the criminal justice system(legal problems) in 31%. At the time of the study,53% maintained family contacts. Participants werereceiving either occasional follow-up (on demandbecause they no longer required regular follow-upor attended irregularly, n = 20), or regular follow-up(a minimum of one to four meetings per month,n = 30). Eighteen clients were lost to follow-up(Table 2).

Gender-related differences

The only statistically significant differences betweenmen and women pertained to current residentialstatus and family contacts (Table 1). Only onewoman (4%) was living on the street, comparedwith 10 men (23%). Conversely, more women (10)than men (5) were living in stabilised circumstances(40% vs. 12%, P = 0.008). Perhaps related to theirgreater residential stability, women were more likelyto have maintained family contacts (76% vs. 40%,P = 0.013, odds ratio 0.25, confidence intervals0.08–0.82). Among other characteristics that coulddifferentiate women and men, the women weremore likely to have been born in Montreal (92% vs.70%), to have been institutionalised (40% vs. 26%)and to have been homeless for less than 1 year(24% vs. 9%). A breakdown in the family or socialnetwork following loss of contact with, or death of,a significant adult was cited by 36% of the womenas the primary factor precipitating homelessness.Among men, substance abuse was the most

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commonly cited precipitating factor, reported by44%, compared with 24% of women. The propor-tion of men with more than three problems atintake was higher than that of women (37% vs.24%). Problems with the criminal justice systemwere more common among men than women (37%vs. 20%), while more women than men had prob-lems related to prostitution (20% vs. 9%). Moremen than women reported having no specificdaytime activity at the time of the study (30% vs.20%). Regular follow-up was more frequent amongwomen than men (56% vs. 37%).

Differences related to current residential status

As previously noted, women comprised the majority(67%) of the stabilised circumstances group, with the

street/shelters group being formed almost exclusivelyof men (91%, P = 0.008) (Table 3). Almost two-thirds (64%) of the street/shelters group cited sub-stance abuse as the primary precipitating factor ofhomelessness, compared with only 13% of thestabilised circumstances group (P = 0.03). A singleproblem at intake was observed most frequentlyamong individuals in the stabilised circumstancesgroup (67% vs. 33% in precarious circumstances and0% in street/shelters). In contrast, 64% in the street/shelters group, 33% in the precarious circumstancesgroup and 7% in the stabilised circumstances groupexhibited more than three problems at intake(P = 0.001). A marginally significant difference(P = 0.055) was observed regarding the length ofhomelessness. While 40% of the individuals in thestabilised circumstances group had been homeless for

Table 1 Characteristics of homelesspersons with intellectual disability, bygender

Male Female Total

n % n % n %

Gender 43 63.2 25 36.8 68 100History

Montreal 30 69.8 23 92.0 53 77.9Special education 32 74.4 21 84.0 53 77.9Institutionalisation 11 25.6 10 40.0 21 30.9

Duration of homelessness12 months and less 4 9.3 6 24.0 10 14.713–48 months 5 11.6 2 8.0 7 10.349 months and more 28 65.1 15 60.0 43 63.2No information 6 14.0 2 8.0 8 11.8

Precipitating factorsSubstance abuse 19 44.2 6 24.0 25 36.8Loss/break-up 12 27.9 9 36.0 21 30.9Mental health problems 7 16.3 5 20.0 12 17.6Legal problems 1 2.3 1 4.0 2 2.9Loss of work 1 2.3 0 0.0 1 1.5Other 4 9.3 4 16.0 8 11.8

Problems at intakeMental health 24 55.8 17 68.0 41 60.3Substance abuse 27 62.8 11 44.0 38 55.9Physical health 19 44.2 10 40.0 29 42.6Legal problems 16 37.2 5 20.0 21 30.9Prostitution 4 9.3 5 20.0 9 13.2Other 5 11.6 2 8.0 7 10.3

Number of problems at intake0 0 0 0 0 0 01 14 32.6 10 40.0 24 35.32 13 30.2 9 36.0 22 32.43+ 16 37.2 6 24.0 22 32.4

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less than 1 year, 73% of the persons in the street/shelters had been homeless for more than4 years.

A significant association was observed betweencurrent residential status and problems of sub-stance abuse (P = 0.008) and with the criminaljustice system (P = 0.008) at intake. Substanceabuse problems were present among 90% of indi-viduals in the street/shelters group, while 64% ofindividuals in the same group had problems withthe justice system. A marginally significant(P = 0.057) association was observed betweenphysical health problems and current residentialstatus, with 73% in the street/shelters group, 41% inthe precarious circumstances group and 27% in thestabilised circumstances group exhibiting such prob-lems at intake. There was only one statistically sig-nificant difference regarding current status(Table 4), with greater percentages of individualshaving family contacts in the stabilised circumstancesand precarious circumstances groups than in thestreet/shelters group (73%, 51% and 9%, respec-tively; P = 0.003). Interestingly, at the time of datacollection, 60% of the individuals in the stabilisedcircumstances group were receiving regular follow-up, compared with 27% of those in the street/shelters group, who were more likely to receiveoccasional follow-up (46%).

Discussion

The results reported here describe the situationsof 68 persons referred to a front-line team forhomeless persons on the basis of a diagnosed orsuspected ID. The majority of them had beenhomeless for more than 4 years at the time oftheir referral. The most commonly cited explana-tions for homelessness were substance abuse andrelationship loss or breakdown. More than one-half presented with mental health or substanceabuse problems. More women than men had keptcontact with their families and had stabilised theirresidential status. Persons who were currentlyliving in stabilised circumstances had been home-less for a shorter period than the others, andtwo-thirds of them presented only one problem atintake. A minority in this group cited substanceabuse as a precipitating factor. Three-quarters ofthe persons in this group were in contact withtheir family, and the majority received regularfollow-up. In contrast, almost all the persons inthe street/shelters group were men. Three-quartersof them had been homeless for more than 4 years,and two-thirds had more than three problems atintake. The most commonly cited precipitatingfactor for homelessness in this group was sub-stance abuse, and 90% of the members exhibited

Table 2 Current situations of homelesspersons with intellectual disability, bygender

Male Female Total

n % n % n %

Residential statusStreet/shelter 10 23.3 1 4.0 11 16.2Precarious 28 65.1 14 56.0 42 61.8Stabilised 5 11.6 10 40.0 15 22.1**

Regular activityDay centre 14 32.5 7 28.0 21 30.9Structured activity 7 16.3 6 24.0 13 19.1None 13 30.2 5 20.0 18 26.5No information 9 20.9 8 32.0 17 25.0

Contact with family 17 39.5 19 76.0 36 52.9*Type of follow-up

Regular 16 37.2 14 56.0 30 44.1Occasional 16 37.2 4 16.0 20 29.4Lost to follow-up 11 25.6 7 28.0 18 26.5

* P < 0.05; ** P < 0.01.

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substance abuse problems. A majority of them hadphysical health problems and were involved withthe criminal justice system. Very few had main-tained family contact. Occasional or no follow-upwas the norm.

These results must be considered in light of thelimitations of this exploratory study. One suchlimitation is sample bias. Individuals referred tothe outreach team are those perceived as mostvulnerable, those who cannot cope in an adverseenvironment and who encounter severe financialor sexual exploitation. In the absence of any

formal diagnosis, it could be that some partici-pants did not have an ID, having acquired theirintellectual limitations in adulthood as a result ofa life of extreme poverty, excessive consumptionof psychoactive substances, or repeated cranialtrauma. Finally, this study is based on retrospec-tive, secondary data and a cross-sectionaldesign.

In spite of these limitations, the findings givesome indications as to the presence of persons withID within the homeless population. Consideringthat Montreal’s homeless population was estimated

Table 3 Characteristics of homeless persons with intellectual disability, by residential status

Street/shelter Precarious Stabilised Total

n % n % n % n %

Status 11 16.2 42 61.8 15 22.1 68 100.0Gender

Male 10 90.9 28 66.7 5 33.3 43 63.2**Female 1 9.1 14 33.3 10 66.7 25 36.8

HistoryMontreal 9 81.8 32 76.2 12 80.0 53 77.9Special education 9 81.8 30 71.4 14 93.3 53 77.9Institutionalisation 1 9.1 14 33.3 6 40.0 21 30.9

Duration of homelessness<12 months 2 18.2 2 4.8 6 40.0 10 14.713–48 months 1 9.1 4 9.5 2 13.3 7 10.3�49 months 8 72.7 28 66.7 7 46.7 43 63.2No information 0 0.0 8 19.0 0 0.0 8 11.8

Precipitating factorsSubstance abuse 7 63.6 16 38.1 2 13.3 25 36.8*Loss/break-up 3 27.3 13 31.0 5 33.3 21 30.9Mental health problems 2 18.2 6 14.3 4 26.7 12 17.6Legal problems 0 0.0 1 2.4 1 6.7 2 2.9Loss of work 0 0.0 0 0.0 1 6.7 1 1.5Other 0 0.0 6 14.3 2 13.3 8 11.8

Problems at intakeMental health 6 54.5 25 59.5 10 66.7 41 60.3Substance abuse 10 90.0 25 59.5 3 20.0 38 55.9**Physical health 8 72.7 17 40.5 4 26.7 29 42.6Legal 7 63.6 13 31.0 1 6.7 21 30.9**Prostitution 1 9.1 7 16.7 1 6.7 9 13.2Other 1 9.1 4 9.5 2 13.3 7 10.3

Number of problemsat intake1 0 0.0 14 33.3 10 66.7 24 35.32 4 36.4 14 33.3 4 26.7 22 32.43+ 7 63.6 14 33.3 1 6.7 22 32.4***

* P < 0.05; ** P < 0.01; *** P < 0.001.

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at 28 214 in the 1996–1997 census (Chevalier &Fournier 1998), this presence might appear to rep-resent a marginal problem. However, it is importantto remember the acknowledged ‘invisibility’ of ID(Talbot & Riley 2007): persons with ID are oftenmisclassified; ID may be masked by other problemsand only the most vulnerable are referred to theoutreach team.

Homeless persons with ID seem to present withspecific characteristics within the homeless popula-tion. When compared with homeless personswithout ID living in the same urban environment,differences can be observed. The results of thisstudy were compared with those of an epidemio-logical study of homeless persons (n = 509) con-ducted in Montreal and Quebec in 1998–1999

(Institut de la Statistique du Québec 2004). Tomake these comparisons, it was however necessaryto exclude individuals in the stabilised circumstances,as the participants to the 1998–1999 survey hadbeen recruited in services for the homeless. Thegroup compared with this survey then comprised 53

participants. A first difference was the higher pro-portion of women in the group of homeless personswith ID (28%) than in the general population ofthe homeless (14%). However, this difference mightbe explained by rapid growth in the number ofwomen among the homeless since the time of thatstudy. Walsh et al. (2009) reported rates of approxi-mately 25% of women in homeless populations in

recent studies. Among other differences, the propor-tion of persons living in the street and/or in shelterswas lower among homeless persons with ID (21%)than in the overall homeless population (45%).Persons with ID were more likely to still live in thecity of their birth (77% vs. 55%) and to maintaincontact with their family (47% vs. 18%), which mayindicate less social deprivation. Physical healthproblems and problems with the criminal justicewere markedly less common among homelesspersons with ID (47% and 38%, respectively) thanin the general homeless population (73% and 80%,respectively). The proportions of individuals withproblems related to mental health, substance abuseor prostitution were fairly comparable in the twogroups.

Implications for policy

Very few programmes have been designed tosupport homeless persons with ID or to preventhomelessness among this population. The findingsfrom the comparisons by gender or current residen-tial status reveal considerable variability in theseverity of homelessness in the study population.They point the way towards specific interventionstrategies to deal with homelessness among personswith ID. First, women with ID appear to be less atrisk of absolute homelessness, with only one womanin our study living in the street and/or in a shelter.

Table 4 Current status of homeless persons with intellectual disability, by residential status

Street/shelter Precarious Stabilised Total

n % n % n % n %

Regular activityDay centre 6 54.5 12 28.6 3 20.0 21 30.9Structured activity 0 0.0 9 21.4 4 26.7 13 19.1None 4 36.4 14 33.3 0 0.0 18 26.5No information 1 9.1 8 19.0 8 53.3 17 25.0

Contact with family 1 11.1 24 66.7 11 78.6 36 52.9**Type of follow-up

Regular 3 27.3 18 42.9 9 60.0 30 44.1Occasional 5 45.5 11 26.2 4 26.7 20 29.4Lost to follow-up 3 27.3 13 31.0 2 13.3 18 26.5

* P < 0.05; ** P < 0.01.

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The literature also indicates that homeless womenprefer living in community housing, in roominghouses or with roommates, rather than staying inthe street during the day while waiting for the shel-ters to open at night (see Walsh et al. 2009, for areview). The homelessness specialist who is aco-author of this study also observed that homelesswomen with ID were more likely to seek stable andsafe lodging, and to avoid dependence on servicesintended for the homeless, in an effort to escapesolicitation for the purposes of prostitution or pro-posals to consume alcohol or drugs. Our data alsoconfirm the tendency for women with ID to enterfollow-up programmes earlier in their homelessexperience than men. Two other factors may explainthe fact that they achieved stability in greaternumbers than men: more of them maintainedcontact with their families, and they were morelikely to participate in regular follow-up.

Among those persons who had regained residen-tial stability, 40% had lived in the streets or sheltersfor less than 1 year, and two-thirds had exhibitedonly a single problem at intake. In contrast, whenhomelessness becomes deeply entrenched, untreatedconditions can deteriorate and necessitate pro-longed rehabilitation because of the number andseverity of problems. These results indicate the rel-evance of intervening as early as possible when aperson with ID no longer has a fixed address,that is, when a focused intervention on a limitednumber of associated problems is still possible.Finally, for two-thirds of the homeless persons withID in our study, substance abuse or breakdowns intheir social network were mentioned as the mostimportant precipitating factors for homelessness. Interms of prevention, these two features should beconsidered factors that predispose a person with IDto precarious residential status and should betreated accordingly.

Conclusion

This article presented data on persons with ID whowere confronted with very precarious residentialcircumstances. Some experienced relatively shortperiods of homelessness and migrated to stabilisedcircumstances once they were identified and fol-lowed up. For others, transient life was chronic

and marked by numerous other problems. In theabsence of prevalence data, it is impossible to evalu-ate the extent of the problem represented bypersons with ID and multiple other problems livingon the street. The need for epidemiological researchis even clearer in light of the fact that below-averageintellectual functioning has been identified as a riskfactor for homelessness and for vulnerability amongthe homeless.

Authors’ notes

The authors would like to thank the Centre de réad-aptation en déficience intellectuelle Lisette-Dupras andthe Centre de Santé et de services sociaux Jeanne-Mance for their support to this study. They alsowish to acknowledge the contributions of GenevièveBoyer, Isabelle Jacques and Claudel Parent-Boursierin the data management, as well as the referee’scomments, which have been incorporated in thetext. With regard to competing interests, CélineMercier and Sylvain Picard declare that, at the timeof this study, they were employees of the Centre deréadaptation en déficience intellectuelle Lisette-Dupras.A preliminary version of the results from this studywas presented at the 13th World Congress of theInternational Association for the Scientific Study ofIntellectual Disabilities (Cape Town, August 2008).

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Accepted 23 November 2010

449Journal of Intellectual Disability Research volume 55 part 4 april 2011

C. Mercier & S. Picard • Intellectual disability and homelessness

© 2011 The Authors. Journal of Intellectual Disability Research © 2011 Blackwell Publishing Ltd