# Presentation: 381750

## Addressing the Needs of Homeless Families:Implications of the Evidence

**Debra Rog, Ph.D.**
**Vanderbilt Institute for Public Policy Studies**
**Presented at the Policy Academy for State and Local Policymakers on Improving Access to Mainstream Services for Homeless Families with Children**
**January 28, 2004**

## Today’s Presentation

**How do the needs of homeless families compare with families in poverty and the overall population?**
**What works in addressing homelessness?**
**What more can be done?**

## Main Sources of Research

**Longitudinal Study of First-time Homeless Families and Comparison Families in NYC (Shinn, et al., 1998)**
**Worcester Family Research Project (Bassuk, et al., 1996)**
**RWJ/HUD Homeless Families Project (Rog, et al., 1995)**
**NSHAPC (Burt, et al., 1999)**

## The Prevalence of Family Homelessness

**Families now comprise 34% of the homeless population**
**11% are parents with children**
**23% are their children**
**Over a year, approximately 1.8% of all families are homeless at least one day – 8% of all poor families**

## Demographic Snapshot of Homeless Families

**70-90% female headed **
**Average age is late 20s**
**Average of 2-3 children, most of them under 6 years of age **
**Overrepresentation of people of color (66%)**
**Overrepresentation of families with young children**
**The risk increases the younger the children**

## Family Homelessness is a Pattern of Residential Instability 

**In the 9 city RWJ/HUD project, families:**
**Moved avg. of 5 times in prior 18 mos**
**Spent:  7 months doubled up**
**	****	****    ****6 months in their own home  ****	****   **
** ****	****	****    ****3.5 months homeless**
**53% had prior homelessness**
**Similar patterns in WFRP**

## Human Capital

**  ****Many have work experience, generally **
**     ****low-wage**
**62% with job > 1 yr (RWJ/HUD)**
**67% with job > 3 mos (WFRP)**
**  ****Few working while homeless**
**13% (RWJ/HUD)**
**<1% (WFRP)**
**  ****Education levels are low**
**25% nationally without HS/GED  vs.**
**42% (RWJ/HUD)**
**46% (WFRP)**
**53% (NSHAPC)**

## Health Care Needs

**More acute and chronic health problems than general population of females under 45 yrs old **
**Examples (WFRP):**
**22% report chronic asthma (>4x gen. rate)**
**20% report chronic anemia (10x gen. rate)**
**4% report chronic ulcers (4x gen. rate)**
**In RWJ/HUD study: **
**26% reported 2 or more health problems in past year**
**31% characterized health as fair or poor **
**However, most (75%) had access to health services while homeless, typically through Medicaid**

## Violence and Trauma

**Many mothers report histories of childhood abuse**
**Physical Abuse**
**67% (WFRP)**
**33% (RWJ/HFP)**
**Sexual Abuse**
**43% (WFRP)**
**32% (RWJ/HFP)**
**Majority report severe violence by adult intimate partner(s)**
**63% (WFRP)**
**65% (RWJ/HFP)**

## Mental Health Needs

**Depression, anxiety, PTSD are most common mental health crises**
**35% had MH disorder (WFRP)**
**44% MH problems (NSHAPC)**
**60% were “currently distressed” (RWJ/HUD)**

## Suicidality is troubling

% who report attempting suicide
27% (WFRP)
31% (RWJ/HUD)

Over half reported multiple attempts in both studies

43% of recent attempts resulted in hospitalizations (RWJ/HUD)

**% who report attempting suicide**
**27% (WFRP)**
**31% (RWJ/HUD)**
**Over half reported multiple attempts in both studies**
**43% of recent attempts resulted in hospitalizations (RWJ/HUD)**

## Lifetime Use
41% (WFPP) – any substance dependence
50% (RWJ/HUD) – ever used hard drugs 

Current Use
5% (WFRP) – use in past month
29% (RWJ/HUD) – “alcoholic”
12% (RWJ/HUD) – hard drug use in past yr

**41% (WFPP) – any substance dependence**
**50% (RWJ/HUD) – ever used hard drugs **
**Current Use**
**5% (WFRP) – use in past month**
**29% (RWJ/HUD) – “alcoholic”**
**12% (RWJ/HUD) – hard drug use in past yr**

**Substance Use Needs**

## Homeless Children Needs

**Homelessness disrupts children’s:**
**Family stability**
**22% of homeless children spend some time apart from their family in a typical year, with 12% placed in foster care**
**School stability**
**At least 1/5 of children who are homeless do not attend school **
**More than 1/4 attended 3 or more schools in a year**

**Consequently, homelessness has negative implications for children’s:**
**Mental health**
**Behavior**
**Educational progress**

## Putting Homeless Families Needsin Context

**Studies comparing homeless and domiciled poor women find no differences in rates and nature of:**
**Mental health needs **
**Physical health needs**
**Educational and work history**
**Majority of differences between homeless and other poor families have to do with resources and life stage**

## Homeless families, compared to poor domiciled families, are more likely to:

Have fewer economic resources
Have younger heads of households
Be people of color, especially African-American
Abuse substances
Have their children negatively affected by disruptions

**Have fewer economic resources**
**Have younger heads of households**
**Be people of color, especially African-American**
**Abuse substances**
**Have their children negatively affected by disruptions**

## Breaking the Cycle of Family Homelessness

**Affordable housing matters**
**Subsidized permanent housing = major predictor of residential stability  (NYC)**
**88% receiving Section 8 certificates and services remain housed for 18 months or more (RWJ/HUD)**
**# of other studies find evidence of the role of subsidies in foster stability**

## Little is known about tradeoffs between transitional housing and permanent housing
No systematic controlled studies
Data on families’ stability in permanent housing question need for transitional housing

**No systematic controlled studies**
**Data on families’ stability in permanent housing question need for transitional housing**

## Addressing the Other Needs of Families

**Mixed evidence on role of services**
**In the RWJ/HUD study:**
**CM increased access to a range of services **
**Little change in families’ progress toward self-sufficiency or other needs**
**Housing locators improved housing access**
**One comparison study found no effects for services; another study found reduced risk for families with MH & SA needs**

## The current SAMHSA study of mental health and substance abuse interventions:
Promises to shed light on effective services and key ingredients of their delivery
May have relevant findings re: the role of services with housing
Several of the projects include transitional housing or permanent housing as part of the intervention 

**Promises to shed light on effective services and key ingredients of their delivery**
**May have relevant findings re: the role of services with housing**
**Several of the projects include transitional housing or permanent housing as part of the intervention**** **

## Implications From the Literature

**Access to “affordable housing” increases residential stability **
**Subsidies are important **
**Multiplicity of families needs suggests:**
**Multifaceted intervention approach**
**Approach needed by poor families in general**

## Individual solutions not likely to be effective for the majority

Solutions needed for increasing the “affordability” and “housing” parts of the equation

**Solutions needed for increasing the “affordability” and “housing” parts of the equation**

## Affordability Options
Livable wage
Maximizing, preserving, expanding EITC
Using CDBG to support permanent housing
Using TANF for housing assistance

**Livable wage**
**Maximizing, preserving, expanding EITC**
**Using CDBG to support permanent housing**
**Using TANF for housing assistance**

**Policy Options**

## Housing Policy Options
Redirect TH to permanent housing (perhaps with stabilization services)
Examine/evaluate Housing First approaches
Convert existing TH to transition-in-place

Prevention Policy Options
Target high risk groups
Young families with young children
Youth age
High-risk 
Families who re-enter/shelter

**Redirect TH to permanent housing (perhaps with stabilization services)**
**Examine/evaluate Housing First approaches**
**Convert existing TH to transition-in-place**
_**Prevention Policy Options**_
**Target high risk groups**
**Young families with young children**
**Youth age**
**High-risk **
**Families who re-enter/shelter**

## Acting on the Research

**Combination of options may be warranted**
**Choose options with broad perspective**
**Guard against:**
**Redistribution**
**Perverse incentives**
**Accompany actions with controlled, rigorous evaluation that also has broad perspective**
**Attend to local variation, especially in prevention**