# Presentation: 552824

## Addressing Chronic Homelessness

**Issues and Promising Practices **

## Chronic Homelessness

- HHS, HUD, and VA use the following working definition of chronic homelessness in their collaborations:
**An unaccompanied individual with a disabling condition who has either been continuously homeless for a year or has had at least 4 episodes of homelessness in the past 3 years**

## How Many?

- 80% of the estimated 2 to 3 million people who experience homelessness each year exit within 3 to 4 weeks
- 10% are homeless more episodically
- 10% experience chronic homelessness

## Why Address Chronic Homelessness?

- They have greater difficulty exiting homelessness on their own
- Although small in numbers, they use half of all emergency assistance for people who are homeless
- Placing them in supportive housing saves money

## Who Are They?

- At least 75% male, 40% of whom are veterans
- At least 40% African American
- Tend to be older

## What Issues Do They Face?

- 40% have substance use disorders
- 25% have physical disabilities or disabling health conditions
- 20% have serious mental illnesses
- 66% have more than one of these conditions

## What Prevents Them from Exiting Homelessness?

- Persistent poverty
- Lack of affordable housing
- Disabling health and behavioral health conditions
- Service system barriers

## Poverty

- Most rely on public entitlement programs (e.g., SSI, SSDI, VA) for income
- Even with income support, they remain below the Federal poverty level
- Many do not receive benefits they are entitled to
- People with a primary diagnosis of a substance use disorder are not eligible for SSI

## Housing

- Lack of affordable housing options for very low-income people
- People with disabilities on SSI must pay 105% of income to rent a modest one-bedroom unit at Fair Market Rent
- Average wait for Section 8 rental assistance is more than 2 years

## Disability

- 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

## Service System Barriers

- Service systems and funding are fragmented
- Administrative procedures are restrictive and burdensome
- Resources (housing and services) are insufficient
- Treatment and services programs are sometimes ineffective

## What Works?       -Core Services

- Outreach and engagement
- A range of housing options with flexible support services
- Clinical case management
- Integrated health and behavioral health care
- Substance abuse treatment
- Primary health care
- Mental health treatment
- Income support and entitlement assistance

## What Works?    -Supportive Services

- Rehabilitation, training, and employment services
- Life skills training
- Legal assistance
- Transportation

## What Works?        -Prevention Services

- Comprehensive discharge planning from shelters, hospitals, and jails
- Time-limited, intensive supports during periods of transition
- Crisis intervention

## The Challenge...

- 	To ensure that people who experience chronic homelessness have full access to both targeted and mainstream programs

## Mainstream Federal Programs

**Income/Employment**
- Department of Labor programs
- SSI/SSDI
- TANF
**Services**
- Medicaid
- Mental Health Block Grant
- Substance Abuse Block Grant
- Community Health Centers
- Community Services Block Grant
- Social Services Block Grant

**Housing**
- Section 8
- HOME
- HOPWA
- Community Development Block Grant
- Section 811
**Veterans Programs**

## Action Plans to Address Chronic Homelessness 

**State Activities and Accomplishments**

## Common Priority Areas/Themes

- Increasing coordination and collaboration
- Data/information gathering and integration of data systems
- Increasing access to mainstream system resources
- Increasing supply of/access to affordable housing
- Increasing prevention and discharge planning
- Implementing best practices
- Increasing public education and awareness

## Key Strategies for Increasing Coordination and Collaboration

- Implement/reactivate ICH
- Develop and support infrastructure to ensure ongoing activity and progress on plan implementation
- Continued involvement of Policy Academy Team members and/or key leadership
- Enhanced partnerships through expanded membership/ inclusion of new stakeholders
- Integration of planning activities (e.g., family/chronic, State/local/Continuum of Care plans)

## Key Data/Information Strategies

- Studies to estimate numbers/need (e.g., point-in-time surveys)
- Cost studies
- Housing status as uniform data item within all mainstream data collection systems
- Development/implementation of HMIS systems and integration with other (mainstream) data systems
- Development of performance/outcome measures, using HMIS and mainstream data systems to monitor progress

## Strategies for Increasing Access to Mainstream Resources

- Universal application for TANF, Food Stamps, Medicaid
- Streamlining eligibility/training to improve access to SSI/SSDI
- Collaboration/cross-training with Veterans, Employment, Mental Health, Substance Abuse programs on homelessness
- Use of TANF and Medicaid funding for services (e.g., housing assistance, mental health/ACT services)
- Using mainstream housing resources (e.g., HOME, CDBG)

## Strategies to Increase Supply of/Access to Affordable Housing

- Public/private partnerships and Housing Trust Funds to develop affordable housing
- Use of CDBG, HOME, State funds to create new housing and/or subsidy programs
- Increasing income through employment training and access to income supports
- Modification of eligibility requirements for housing
- Landlord outreach, advocacy, and support
- Provider training on housing chronically homeless people

## Prevention Strategies

- Identification of risk factors and targeting prevention efforts to specific subgroups (e.g., substance abusers)
- Development, implementation and monitoring/enforcement of discharge policies that prevent homelessness (zero- tolerance policies)
- Pilot programs for ex-offenders (in-reach, housing assistance, post-release support services )
- Creating/setting aside housing for people exiting mental health institutions, other at-risk populations

## Implementation of Best Practices 

- Implementation of Housing First approach
- ACT as standard case management model
- Increased outreach with linkage to housing and services
- Pilot projects testing new approaches to housing and service integration

## Increasing Education and Awareness

- Statewide conferences/summits on housing and homelessness
- Public awareness campaigns (TV, print, radio)
- Educating policymakers