**[Slide1:]{.underline}**

**Characteristics and Service Needs Of Individuals and Families
Experiencing Homelessness**

**[Slide2:]{.underline}**

Overview

-   What do we know about individuals and families who experience
    homelessness?

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-   What are the risk factors for homelessness?

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-   What do we know about interventions that work for homeless
    individuals and families?

**[Slide 3:]{.underline}**

How Many People Experience Homelessness

-   An estimated 800,000 people are homeless each week.

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-   2-3 million people are homeless over the course of a year.

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-   80 percent of people who experience homelessness exit within 3-4
    weeks.

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-   10percent are homeless more episodically.

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-   10percent experience chronic homelessness.

**[Slide 4:]{.underline}**

Chronic Homelessness

HHS, HUD, and VA use the following working definition in their
collaborations:

**An unaccompanied individual with a disabling condition who has either
been continuously homeless for a year or has had at least four (4)
episodes of homelessness in the past three (3) years.**

**[Slide 5:]{.underline}**

Why Address Chronic Homelessness

-   Chronically homeless people have greater difficulty exiting
    homelessness on their own.

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-   Although small in numbers, they use half of all emergency assistance
    for people who are homeless.

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-   Placing them in supportive housing saves money.

**[Slide 6:]{.underline}**

Who Experiences Chronic Homelessness?

-   At least 75 percent male, 40 percent of whom are veterans

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-   At least 40 percent African American

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-   Tend to be older

**[Slide 7:]{.underline}**

What Issues Do They Face?

-   40 percent have substance use disorders.

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-   25 percent have physical disabilities or disabling health
    conditions.

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-   20 percent have serious mental illnesses.

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-   66 percent have more than one of these conditions.

**[Slide 8:]{.underline}**

Family Homelessness

-   Together, parents and their children comprise 34 percent or more of
    the homeless population:

-11 percent are parents with children

-23 percent are children under 18 with a parent.

-   84 percent are single mothers.

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-   Average age - late 20s

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-   Average 2-3 children, most under age 6

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-   66 percent are women of color (African American, 44 percent; Latina,
    16 percent; Native American, 6 percent).

**[Slide 9:]{.underline}**

What Do We Know About Family Homelessness?\*

-   50 percent are homeless for first time

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-   25 percent are homeless more than a year.

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-   29 percent are homeless for first time before age 18.

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-   25 percent experienced out-of-home placement before age 18.

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-   Family homelessness is expensive:

    -   Average annual cost of shelter for a homeless family in NYC is
        \$25,000 per year.

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-   33 percent of family requests for shelter went unmet in 2003.

\*Based on women with children.

**[Slide 10:]{.underline}**

What Health Care Issues Do Homeless People Face?\*

-   27 percent have no insurance; 67 percent have Medicaid.

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-   27 percent needed, but not able to get medical treatment in past
    year.

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-   45 percent had one or more chronic health conditions.

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-   In one study, 48percent had at least one family member with a
    disability or chronic illness.

\*Based on women with children.

**[Slide 11:]{.underline}**

What Are The Behavioral Health Needs of Homeless People?\*

-   23 percent: Problems with alcohol

-   27 percent: Problems with drugs

-   44 percent: Mental health problems (primarily depression, anxiety,
    PTSD)

-   58 percent: One or more of the above

\*Based on women with children; self-report of problems within past
year.

**[Slide 12:]{.underline}**

Experience of Violence\*

-   67 percent: Severe childhood physical abuse

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-   43 percent: Childhood sexual abuse

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-   63 percent: Severe violence by adult intimate partner(s)

\*Based on women with children.

**[Slide 13:]{.underline}**

What Issues Do Homeless Children Face?

-   Homeless children go hungry at twice the rate of other children.

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-   Nearly 25 percent have witnessed acts of violence in their families,
    usually against their mother.

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-   They experience physical and sexual abuse at 2-3 times the rate of
    other children.

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-   22 percent of homeless children spend some time apart from their
    family in a typical year, with 12 percent placed in foster care

**[Slide 14:]{.underline}**

Needs of Homeless Children

[Educational and Learning Difficulties]{.underline}

-   At least one-fifth of children who are homeless do not attend
    school.

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-   More than one-fourth have attended three or more schools in a year.

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-   18 percent of homeless children have developmental delays -- four
    times the rate for other children.

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-   Children who are homeless are diagnosed with learning disabilities
    such as dyslexia or speech and language impediments twice as often
    as other children.

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-   Children who are homeless are twice as likely as other children to
    repeat a grade.

**[Slide 15:]{.underline}**

Needs of Homeless Children

[Emotional and Behavioral Problems]{.underline}

-   12 percent of preschoolers and 47 percent of school-age children who
    are homeless have anxiety, depression, withdrawal, and other
    clinical problems.

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-   16 percent of homeless preschoolers have behavior problems,
    including severe aggression and hostility.

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-   36 percent of school-age homeless children exhibit aggressive or
    delinquent behavior.

**[Slide 16:]{.underline}**

What about homeless youth?

-   5% of those ages 12-17 (more than 1 million) are homeless in a given
    year

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-   Adolescents at greater risk than adults

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-   High rates of emotional/mental health problems, substance use,
    medical issues

**[Slide 17:]{.underline}**

Common risk factors/issues...

-   Family conflict/abuse

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-   Disrupted family history

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-   Residential instability

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-   Institutional discharge/"aging out" of foster care

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-   Lack of alternative placements

**[Slide 18:]{.underline}**

What Prevents Individuals and Families With Children From Exiting
Homelessness?

-   Persistent poverty

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-   Lack of affordable housing

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-   Disabling health and behavioral health conditions

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-   Service system barriers.

**[Slide 19:]{.underline}**

Poverty

-   Most rely on public entitlement programs (e.g., SSI, SSDI, VA) for
    income.

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-   Even with income support, they remain below the federal poverty
    level (\$437 per month -- median income for homeless women with
    children; for mothers with two children, this is 43 percent of the
    federal poverty level).

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-   Many do not receive benefits they are entitled to.

**[Slide 20:]{.underline}**

Housing

-   Lack of affordable housing options for very low-income people.

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-   People with disabilities on SSI must pay 105 percent of income to
    rent a modest one-bedroom apartment at Fair Market Rent (FMR).
    Full-time minimum wage worker cannot afford a one- bedroom apartment
    at FMR anywhere in the U.S.

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-   1 in 4 renter households defined by HUD as "struggling renter
    households," pays more than 50 percent of their income for rent

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-   Average wait for Section 8 rental assistance more than two years.

**[Slide 21:]{.underline}**

Homeless People With Disabilities

-   Have multiple needs that can't be addressed by one system

-   Burden of accessing and coordinating services and treatment falls on
    the individual

-   Stigma and discrimination are major barriers to accessing housing
    and services.

**[Slide 22:]{.underline}**

Service System Barriers

-   Service systems and funding are fragmented

-   Administrative procedures are restrictive and burdensome

-   Resources for housing and services are insufficient

-   Treatment and services programs are sometimes ineffective.

**[Slide 23:]{.underline}**

What works?

[Core Services]{.underline}

-   Outreach and engagement

-   A range of housing options with flexible support services

-   Clinical case management

-   Integrated health and behavioral health care

    -   Substance use treatment

    -   Primary health care

    -   Mental health treatment

-   Income support and entitlement assistance.

**[Slide 24:]{.underline}**

What works?

[Supportive Services]{.underline}

-   Rehabilitation, training, and employment services

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-   Life skills training

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-   Legal assistance

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-   Transportation

**[Slide 25:]{.underline}**

What works?

[Prevention Services]{.underline}

-   Comprehensive discharge planning from shelters, hospitals, and jails

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-   Time-limited, intensive supports during periods of transition

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-   Crisis intervention

**[Slide 26:]{.underline}**

Targeted Federal Programs

**HHS Programs**

-   Health Care for the Homeless (HCH)

-   Projects for Assistance in Transition from Homelessness (PATH)

**VA Programs**

-   Domiciliary Care for Homeless Veterans

-   Homeless Chronically Mentally Ill Veterans Program

-   Health Care for Homeless Veterans (HCHV)

-   HUD-VA Supported Housing

**HUD Homeless Assistance**

-   Emergency Shelter Grants (ESG)

-   Supportive Housing Program (SHP)

-   Shelter Plus Care (S+C)

-   Section 8 Single Room Occupancy (SRO)

**[Slide 27:]{.underline}**

Mainstream Federal Programs

**Income/Employment**

-   Department of Labor programs

-   SSI/SSDI

-   TANF

-   Food Stamps/WIC

**Housing**

-   Section 8

-   HOME

-   HOPWA

-   Community Development Block Grant

-   Section 811

**Services**

-   Medicaid

-   Mental Health Block Grant

-   Substance Abuse Block Grant

-   Community Health Centers

-   Community Services Block Grant

-   Social Services Block Grant

-   Head Start

**Veterans Programs**

**[Slide 28:]{.underline}**

Creating A Comprehensive Service System for Homelessness

-   Support concept of "No Wrong Door" to services

-   Provide services determined by evidence to be effective

-   Change ineffective policies or regulations

-   Leverage existing resources

-   Use mainstream resources

-   Pursue new resources.

**[Slide 29:]{.underline}**

Steps to Achieving a Comprehensive Service System

-   Involve key stakeholders

-   Establish a formal plan

-   Build linkages and partnerships from top-down and bottom-up

-   Enhance funding and other resources

-   Streamline the administration of funding

-   Perform ongoing monitoring and quality assurance