# Presentation: 457003

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

## Overview

- What do we know about individuals and families who experience homelessness?
- What are the risk factors for homelessness?
- What do we know about interventions that work for homeless individuals and families?

## How Many People Experience Homelessness?

- An estimated 800,000 people are homeless each week.
- 2-3 million people are homeless over the course of a year.
- 80 percent of people who experience homelessness exit within 3-4 weeks.
- 10percent are homeless more episodically.
- 10percent experience chronic homelessness.

## 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.**

## Why Address Chronic Homelessness?

- Chronically homeless people 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 Experiences Chronic Homelessness?

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

## What Issues Do They Face?

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

## 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.
- Average age - late 20s
- Average 2-3 children, most under age 6
- 66 percent are women of color (African American, 44   percent; Latina, 16 percent; Native American, 6 percent).

## What Do We Know About Family Homelessness?*

- 50 percent are homeless for first time
- 25 percent are homeless more than a year.
- 29 percent are homeless for first time before age 18.
- 25 percent experienced out-of-home placement before age 18.
- Family homelessness is expensive:
- Average annual cost of shelter for a homeless family in NYC is $25,000 per year.
- 33 percent of family requests for shelter went unmet in 2003.
- *Based on women with children.

## What Health Care Issues Do Homeless People Face?*

- 27 percent have no insurance; 67 percent have Medicaid.
- 27 percent needed, but not able to get medical treatment in past year.
- 45 percent had one or more chronic health conditions.
- In one study, 48percent had at least one family member with a disability or chronic illness.
- *Based on women with children.

## 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.

## Experience of Violence*

- 67 percent: Severe childhood physical abuse
- 43 percent: Childhood sexual abuse
- 63 percent: Severe violence by adult 			      intimate partner(s)
- *Based on women with children.

## What Issues Do Homeless Children Face?

- Homeless children go hungry at twice the rate of other children.
- Nearly 25percent have witnessed acts of violence in their families, usually against their mother.
- They experience physical and sexual abuse at 2-3 times the rate of other children.
- 22 percent of homeless children spend some time apart from their family in a typical year, with 12 percent placed in foster care

## Needs of Homeless Children

- _Educational and Learning Difficulties_
- At least one-fifth of children who are homeless do not attend school.
- More than one-fourth have attended three or more schools in a year.
- 18 percent of homeless children have developmental delays – four times the rate for other children.
- Children who are homeless are diagnosed with learning disabilities such as dyslexia or speech and language impediments twice as often as other children.
- Children who are homeless are twice as likely as other children to repeat a grade.

## Needs of Homeless Children

- _Emotional and Behavioral Problems_
- 12 percent of preschoolers and 47 percent of school-age children who are homeless have anxiety, depression, withdrawal, and other clinical problems.
- 16 percent of homeless preschoolers have behavior problems, including severe aggression and hostility.
- 36 percent of school-age homeless children exhibit aggressive or delinquent behavior.

## What about homeless youth?

- 5% of those ages 12-17 (more than 1 million) are homeless in a given year
- Adolescents at greater risk than adults
- High rates of emotional/mental health problems, substance use, medical issues

## Common risk factors/issues...

- Family conflict/abuse
- Disrupted family history
- Residential instability
- Institutional discharge/”aging out” of foster care
- Lack of alternative placements

## What Prevents Individuals and Families With Children 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 ($437 per month – median income for homeless women with children; for mothers with two children, this is 43 percent of the federal poverty level).
- Many do not receive benefits they are entitled to.

## Housing

- Lack of affordable housing options for very low-income people.
- 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.
- 1 in 4 renter households defined by HUD as “struggling renter households,” pays more than 50 percent of their income for rent
- Average wait for Section 8 rental assistance more than two years.

## 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.

## 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.

## 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 use 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

## 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)

## 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**

## 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.

## 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