# Presentation: 554828

## Characteristics and Service Needs of People Experiencing Chronic HomelessnessDeborah DennisPolicy Research Associates, Inc.Delmar, NYPolicy Academy on Chronic HomelessnessOlympia, WAApril 28, 2004

## Chronic Homelessness

- HHS, HUD, DOL 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.

## How Many?

- 80% of the estimated 2-3 million people who experience homelessness each year exit within 3-4 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 remainbelow the federal poverty level
- Many do not receive benefits they are        entitled to
- People with a primary diagnosis of a sub-stance 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 now more than two 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.

## 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**

## Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and/or           Co-Occurring Substance Use DisordersDecember 2003 Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services

## SAMHSA Blueprint 

- Dispels myths about people who are chronically homeless
- Establishes that housing, treatment and services work for this population
- Works from a strong set of person-centered and recovery-based values
- Identifies evidence-based and promising practices that can be adapted to local contexts
- Provides a Federal perspective on addressing chronic homelessness.

## Before You Begin...

- Understand the Changing Context of Care
- How treatment for mental and addictive disorders has evolved.
- Learn about the Population
- Recognize individual risk factors
- Explore service system challenges
- Learn about societal risk factors.
- Establish Core Values
- Supporting the concept and practice of recovery
- Putting people first
- Creating systems that support recovery.

## Recovery... 

**	**A process of restoring or developing a positive and meaningful sense of identity apart from one’s condition and then rebuilding a life despite, or within, the limitations imposed by that condition.
- Recovery from substance use disorders.
- Recovery from mental illness.
- Recovery from homelessness.

## Systems That Support Recovery...

- Believe in recovery and prove it by offering choice, voice, dignity and respect, and hope.
- Make “any door the right door” to services.
- Use mainstream resources to serve people who are homeless.
- Are flexible/offer low-demand services.
- Tailor services to meet individual needs.
- Develop culturally competent services.
- Involve consumers and recovering persons.
- Offer long-term follow-up support.

## Step 1. Plan for Services...

- Establish a Comprehensive, Integrated System of Care** **
- Develop a base for systems change
- Engage in strategic planning
- Participate in community-wide planning.
- Finance a Comprehensive System of Care
- Streamline existing funding
- Secure additional resources
- Leverage new funds.

## Step 2. Use Evidence-Based and Promising Practices

**Outreach and Engagement**
- Meet immediate, basic needs for food, clothing, and shelter
- Non-threatening, flexible approach to engage and connect people to needed services.
**Housing with Appropriate Supports**
- Includes a range of options from Safe Havens to transitional and permanent supportive housing
- Combines affordable, independent housing with flexible, support services.
**Multidisciplinary Treatment Teams/Clinical Case Management**
- Provides or arranges for clinical, housing and other rehabilitation needs
- Features low caseloads (10-15:1) and 24-hour service availability.

## More Evidence-Based and Promising Practices...

**Integrated Treatment for Co-occurring Disorders**
- Coordinated clinical treatment of both psychiatric and substance use disorders
- Reduces alcohol and drug use, homelessness, and severity of mental symptoms.
**Motivational Interventions/Stages of Change**
- Helps prepare people for active treatment; incorporates relapse prevention
- Must be matched to an individual’s stage of recovery.
**Modified Therapeutic Communities**
- Have been successfully adapted for people who are homeless and people with co-occurring disorders
- .
**Self-Help Programs**
- Often include the 12-step method, with a focus on personal responsibility
- May provide an important source of support for people who are homeless.

## More Evidence-Based and Promising Practices...

**Involvement of Consumers and Recovering Persons**
- Serve as positive role models, help reduce stigma, and can help with outreach and engagement of others
- Should be actively involved in the planning and delivery of services.
**Prevention Services**
- Reduce risk factors and enhance protective factors
- Provide supportive services to people in housing
- Improve discharge planning from hospitals, jail/prison, shelters
- Offer intensive support during transition from one setting to another
- Make sure crisis intervention services address/prevent housing loss.

## Other Essential Services

- Primary health care
- Mental health and substance abuse treatment
- Psychosocial rehabilitation
- Income support and entitlement assistance
- Employment, education, and training
- Services for women
- Low-demand services
- Crisis care
- Family self-help/advocacy
- Cultural competence
- Criminal justice system initiatives

## Step 3. Sustain Services

- Measure Results
- Measure client-level outcomes
- Measure system-level outcomes
- Use management information systems.
- Use Mainstream Resources
- Use mainstream resources to prevent homelessness
- Improve access to mainstream programs
- Expand the capacity of mainstream programs
- Promote coordination and collaboration
- Build the infrastructure of housing and services
- Create public awareness.