Reasons for underutilization of public bureaucracy services by the homeless
This dissertation represents an attempt to understand the service utilization behavior of the homeless and ways the public service bureaucracy can better meet the needs of this population. Other than efforts by Calsyn, Kohfeld and Roades (1993), almost no attention has been directed specifically to why the homeless do not utilize services. The study employs a model of homeless service utilization, based on the medical service utilization model of Andersen (1968) and the help-seeking model of Nelson (1980) to fill this void. In the Andersen model, utilization is believed to be a result of need, predisposing, and enabling factors, while in the Nelson model, the decision to seek help is believed to be a process. Here it is theorized that a combination of the two models, with a particular emphasis on the importance of the first step of problem definition/need recognition, helps to explain utilization. The Andersen-Nelson synthesis model was tested on 343 homeless persons from Central Arkansas shelters. Defining the problem as one in need of government help was found to be key to utilization and number of other factors were found to affect utilization at various points in the help-seeking process.