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Cover
========================================================================== COVER


Report to the Chairman, Subcommittee on Housing and Urban Affairs, Committee on
Banking, Housing and Urban Affairs, U.S.  Senate

May 1994

HOMELESSNESS - MCKINNEY ACT PROGRAMS
PROVIDE ASSISTANCE BUT ARE NOT DESIGNED
TO BE THE SOLUTION

GAO/RCED-94-37

Homelessness


Abbreviations
========================================================================= ABBREV

  ACCESS - Access to Community Care and Effective Services and Supports
  ADAT - Research Demonstration Projects for Alcohol and Drug Abuse Treatment
     of Homeless Persons
  AEH - Adult Education for the Homeless
  AFDC - Aid to Families with Dependent Children
  AIDS - Acquired Immune Deficiency Syndrome
  CDBG - Community Development Block Grant
  CHAS - Comprehensive Housing Affordability Strategy
  CMHS - Community Mental Health Services Demonstration Projects for Homeless
     Individuals Who Are Chronically Mentally Ill
  DCHV - Domiciliary Care for Homeless Veterans
  EHCY - Education for Homeless Children and Youth
  EHP - Emergency Community Services Homeless Grant Program
  EFSP - Emergency Food and Shelter Program
  ESG - Emergency Shelter Grants
  FEMA - Federal Emergency Management Agency
  GAO - General Accounting Office
  GSA - General Services Administration
  HCH - Health Care for the Homeless
  HCHCDP - Health Care for Homeless Children Demonstration Program
  HCHV - Health Care for Homeless Veterans
  HCMI - Homeless Chronically Mentally Ill Veterans
  HFSS - Homeless Families Support Services
  HHS - Department of Health and Human Services
  HUD - Department of Housing and Urban Development
  HVRP - Homeless Veterans Reintegration Projects
  JTH - Job Training for the Homeless
  JTPA - Job Training Partnership Act
  NOFA - Notice of Funds Availability
  OEI - Office of Evaluation and Inspection
  OIG - Office of Inspector General
  PATH - Projects for Assistance in Transition from Homelessness
  RHHA - Rural Homeless Housing Assistance
  SAFAH - Supplemental Assistance for Facilities to Assist the Homeless
  SHDP - Supportive Housing Demonstration Program
  SHP - Supportive Housing Program
  S+C - Shelter Plus Care
  SRO - Section 8 Moderate Rehabilitation Program for Single-Room Occupancy
     Dwellings for Homeless Individuals
  SSDI - Social Security Disability Insurance
  SSI - Supplemental Security Income
  VA - Department of Veterans Affairs

Letter
========================================================================= LETTER

<RCED>

B-254977

May 31, 1994

The Honorable Paul S.  Sarbanes
Chairman, Subcommittee on Housing
 and Urban Affairs
Committee on Banking, Housing
 and Urban Affairs
United States Senate

Dear Mr.  Chairman: 

This report responds to your request that we assess the impact of the Stewart
B.  McKinney Homeless Assistance Act in selected cities.  We assessed the act's
impact in Baltimore, Maryland; San Antonio, Texas; Seattle, Washington; and St. 
Louis, Missouri.  This report is based on the experiences of a wide variety of
experts in these localities and of federal, state, and local government
officials who administer the McKinney Act programs.  It makes recommendations
for disseminating the results of successful McKinney Act research and
demonstration programs and for incorporating successful assistance strategies
into mainstream programs.  It also identifies important issues that the
Congress will need to address if it wants to significantly reduce the problem
of homelessness. 

We are sending copies of this report to the heads of the federal agencies that
administer McKinney Act programs and mainstream assistance programs for
low-income people.  We also are sending copies to those who participated in our
study and to other interested parties.  We will make copies available to others
upon request. 

This work was performed under the direction of Judy A.  England-Joseph,
Director, Housing and Community Development Issues, who can be reached on (202)
512-7631 if you or your staff have any questions.  Major contributors to this
report are listed in appendix III. 

Sincerely yours,

Keith O.  Fultz
Assistant Comptroller General


EXECUTIVE SUMMARY
====================================================================== Chapter 0


   PURPOSE
-------------------------------------------------------------------- Chapter 0:1

Recognizing the need for federal assistance to alleviate homelessness
throughout the nation, the Congress enacted the Stewart B.  McKinney Homeless
Assistance Act in 1987.  This act and subsequent amendments established
emergency food and shelter programs, programs providing longer-term housing and
supportive services, and programs designed primarily to demonstrate effective
approaches for providing the homeless with other services, such as physical and
mental health care, education, and job training. 

The Chairman of the Subcommittee on Housing and Urban Affairs, Senate Committee
on Banking, Housing and Urban Affairs, asked GAO to examine (1) what difference
the McKinney Act programs have made in selected cities' efforts to assist the
homeless, (2) what problems the cities have experienced with the McKinney Act
programs, and (3) what directions the cities' programs for the homeless are
taking and what gaps the McKinney Act programs may fill. 


   BACKGROUND
-------------------------------------------------------------------- Chapter 0:2

For fiscal years 1987 through 1993, the Congress appropriated $4.2 billion for
McKinney Act programs, allocating these funds primarily for emergency food and
shelter programs and longer-term housing programs, such as the transitional
housing program.  About 27 percent of the total funds have been allocated to
other, mostly demonstration and research, programs dealing with physical and
mental health care, education, and job training. 

Five federal departments and one federal agency administer McKinney Act
programs, distributing funds by formula to all eligible entities or by
competitive grant to a limited number of recipients.  The five departments also
administer mainstream programs to assist the general population of qualifying
low-income people through such means as rent subsidies, income supplements, and
social services. 

The McKinney Act established the Interagency Council on the Homeless to oversee
programs and coordinate the delivery of funds and services.  The Council
consisted of the heads of all 12 Cabinet departments and various other federal
agencies and maintained its own administrative staff.  No funds were
appropriated for the Council for fiscal year 1994, but the administration
transferred its responsibilities to a working group on homelessness within the
Domestic Policy Council.  The Department of Housing and Urban Development (HUD)
has staffed and funded this working group. 


   RESULTS IN BRIEF
-------------------------------------------------------------------- Chapter 0:3

In the four cities that GAO studied--Baltimore, St.  Louis, San Antonio, and
Seattle--local officials said that McKinney Act programs were a small but
important source of funds for assisting the homeless.  They credited the
programs with providing resources to expand and improve their existing
emergency services, develop longer-term housing options that offer social
services, and assist homeless people who are mentally ill or have substance
abuse problems.  Local officials further credited the programs with providing
limited funds for education and employment--areas in which few resources had
been targeted to the homeless--and with leveraging funds from other sources. 

Local providers criticized the emphasis in many of the McKinney Act competitive
grant programs on demonstrating rather than sustaining the delivery of
effective services.  The Congress responded to this concern in the supportive
housing program by authorizing the renewal of funding for projects, but similar
action is not planned for health care, education, and job training programs. 
Federal officials maintained that finding effective strategies for delivering
services--not delivering services over the long term--is the primary purpose of
these demonstration and research programs.  The officials expected that the
evaluations their agencies were conducting of these and other McKinney Act
programs would suggest ways of improving service strategies, but they had not
made plans for disseminating this information to all who might need it.  Local
providers further objected to some of the McKinney Act programs' complicated
and duplicative application and reporting requirements.  While federal
officials acknowledged these limitations, they noted that some efficiencies had
already been implemented and said that others would require legislative action. 

In all four cities, local experts expected homelessness to remain a serious
problem because affordable housing is scarce, economies are stagnant, and
governments are reducing funds for assistance.  Consequently, the experts would
like to see funding maintained at current levels for McKinney Act emergency
food and shelter programs but increased for other programs to help fill gaps in
prevention, longer-term housing, and comprehensive services.  However, the
experts generally agree that mainstream assistance programs for low-income
people must also be expanded and made more accessible to the homeless to
significantly improve the current situation. 


   PRINCIPAL FINDINGS
-------------------------------------------------------------------- Chapter 0:4


      MCKINNEY ACT PROGRAMS ARE BUILT
      ON LOCAL ASSISTANCE EFFORTS
------------------------------------------------------------------ Chapter 0:4.1

From 1987 through 1992, the four cities used McKinney Act program funds to
supplement existing emergency services, develop new programs, and conduct
research on ways to deal with the problems of the homeless.  For example, San
Antonio provided food for 20,000 additional people; Seattle developed 24 of its
29 transitional housing facilities; St.  Louis designed a project to help
homeless substance-abusing women with children; and Baltimore tested the
effectiveness of a community treatment program for homeless people with severe
mental illness.  Some providers said that without McKinney Act program funds,
they could have provided emergency services only. 


      PROVIDERS WERE DISSATISFIED WITH
      SOME ASPECTS OF MCKINNEY ACT
      PROGRAMS
------------------------------------------------------------------ Chapter 0:4.2

Local service providers understood the experimental role of the McKinney Act
demonstration and research programs but were dissatisfied because, in the
absence of other funding, this role prevented them from sustaining or expanding
successful approaches for providing critical services to the homeless, such as
mental health care and substance abuse treatment.  Although the Congress
modified the supportive housing program to allow grants to be renewed, it has
not modified other programs.  Unsuccessful applicants for McKinney Act research
funds said that they were missing opportunities to develop programs and deliver
needed services because these were the only funds available for providing some
services. 

According to federal officials, the role of the McKinney Act demonstration and
research programs is to identify and disseminate information on better methods
of dealing with the multiple problems of homeless people.  However, federal
agencies had no plans to disseminate the results of ongoing McKinney Act
program evaluations beyond their individual agencies' normal constituents.  GAO
believes that this information could be useful to a wider range of service
providers.  If sufficiently staffed and funded, the Domestic Policy Council's
working group should be able to periodically consolidate the results of
agencies' McKinney Act program evaluations and disseminate them to the 12,000
parties on its mailing list.  HUD said that it had retained all of the former
Interagency Council's staff and was continuing to fund the working group. 

Some providers, especially those participating in several McKinney Act programs
at the same time, found application and record-keeping requirements burdensome. 
Some needed to hire grant writers to compete for McKinney Act program funds,
and others had to take staff away from helping clients to perform duplicative
administrative tasks.  HUD officials said that past attempts to standardize
reporting requirements had failed because the McKinney Act programs specify
different types of grantees, types of programs, and funding cycles.  While
there is no consensus, some providers and some federal officials believe that
the McKinney Act programs should be consolidated to streamline their
administration.  On April 26, 1994, HUD proposed legislation that would
reorganize its six McKinney Act programs into one comprehensive program whose
funds would be allocated to states and local communities by formula. 


      MCKINNEY ACT PROGRAMS COULD FILL
      SERVICE GAPS BUT NOT END
      HOMELESSNESS
------------------------------------------------------------------ Chapter 0:4.3

In all four cities, local experts expected to continue supplying emergency food
and shelter and to introduce more options for homeless people to improve the
quality of their lives and achieve independence.  The experts wanted the
federal government to continue funding McKinney Act emergency programs at
current levels and to increase funding for other programs to help them fill
service gaps, particularly in the areas of prevention, longer-term housing, and
comprehensive services.  However, the experts also said that the McKinney Act
programs should not be expected to make up for shortcomings in mainstream
assistance programs.  In their view, the mainstream programs should be expanded
to serve all who are in need, made more accessible to the homeless, and linked
more closely to programs targeted specifically to the homeless.  GAO found that
none of the federal agencies had planned systematically to incorporate
successful service strategies from their McKinney Act programs into their
mainstream assistance programs. 

Although the federal government has assisted the homeless through McKinney Act
programs, homelessness remains a serious problem.  GAO believes a strategy
beyond the present scope of these programs' resources is needed.  Two federal
initiatives could support the development of a broader strategy.  A task force
on homelessness established by the Speaker of the House of Representatives has
recommended improvements in existing McKinney Act programs, better services to
prevent homelessness, and better access for the homeless to mainstream
assistance programs.  Other recommendations will be made in a coordinated
federal plan to end homelessness that is being prepared by the Domestic Policy
Council's working group and is scheduled for public release on May 17, 1994. 


   MATTERS FOR CONGRESSIONAL
   CONSIDERATION
-------------------------------------------------------------------- Chapter 0:5

To reduce the administrative burden created by multiple application and
reporting requirements, the Congress may wish to amend the McKinney Act to (1)
enable federal agencies to establish more uniform application and reporting
requirements or (2) consolidate McKinney Act programs. 


   RECOMMENDATIONS
-------------------------------------------------------------------- Chapter 0:6

GAO recommends that the Executive Director of the Domestic Policy Council's
working group on homelessness periodically consolidate and disseminate
summaries of the agencies' McKinney Act program evaluations to the parties on
its mailing list. 

GAO recommends that the Secretaries of HUD, Health and Human Services, Veterans
Affairs, Labor, and Education incorporate into their mainstream assistance
programs successful strategies for working with the homeless that are
identified in evaluations of their McKinney Act programs. 


   AGENCY COMMENTS
-------------------------------------------------------------------- Chapter 0:7

GAO discussed a draft of this report with key officials in the agencies to
which GAO's recommendations apply:  the Deputy Assistant Secretary for Economic
Development, HUD; the Deputy Assistant Secretary for Program Systems in the
Office of the Assistant Secretary for Planning and Evaluation, Department of
Health and Human Services; the Associate Director, Policy and Operations,
Mental Health and Behavioral Science Services, Department of Veterans Affairs;
the Chief of Adult and Literacy Research and Demonstration Programs, Department
of Labor; a Senior Advisor in the Division of Adult Education and Literacy,
Department of Education; and the former Executive Director of the Interagency
Council on the Homeless.  These officials generally agreed with GAO's findings
and recommendations.  Their comments have been incorporated as appropriate.  As
requested, GAO did not obtain written agency comments on a draft of this
report. 


INTRODUCTION
====================================================================== Chapter 1

Although homelessness is not a new problem, its causes during the past decade
have been more complex and its effects more widespread than in earlier times. 
Once consisting primarily of transient adult males, the homeless population now
includes women, families with children, the mentally ill, victims of domestic
violence, the unemployed, and individuals who are working yet not earning
enough to pay for housing.  The population is also younger and comprises larger
proportions of racial and ethnic minorities than in years past. 

The homelessness of the past decade is becoming entrenched.  The impact of the
current economic recession is difficult to gauge, but budget cuts by state and
local governments are exacerbating the problem and increasing the need for
services to the homeless, according to a Federal Emergency Management Agency
(FEMA) Emergency Food and Shelter Program survey released in May 1992. 

No one is certain how many people in the United States are homeless.  Estimates
made during the 1980s vary substantially but, to our knowledge, are the best
available.  For example, the Department of Housing and Urban Development (HUD)
reported that on any given night during December 1983 and January 1984, between
250,000 and 350,000 persons were homeless.\1 Several years later, The Urban
Institute, using a different definition of homelessness, estimated that about
600,000 individuals were homeless on any night in 1987.\2 In addition to those
who are literally homeless (i.e., persons sleeping on the streets or in parks,
cars, abandoned buildings, or shelters) many more are precariously housed and
at imminent risk of becoming homeless.  Some of these are living doubled up
with friends or relatives or are about to be evicted. 

Addressing the needs of homeless people has proven to be a formidable challenge
because, as research has found, homelessness is seldom traceable to a single
cause and is often not an isolated problem.  Homeless people today usually have
personal, social, and economic problems that prevent them from maintaining
permanent housing.  These problems can include mental illness, severe physical
health problems, lack of income or employment, alcohol or drug abuse, and
domestic violence.  Specialized assistance in the form of outreach to clients
on the street and comprehensive supportive services within shelters has evolved
to help homeless people who may be too ill, intoxicated, debilitated, poor,
alienated, or intimidated to obtain access to social services on their own. 
Also, individuals and families may drift in and out of homelessness several
times as a result of changes in their economic circumstances or of setbacks in
coping with serious problems, such as substance abuse.  Figure 1.1 illustrates
the range of housing and services that persons moving in and out of
homelessness may need. 

   Figure 1.1:  Housing and Service
   Needs of the Homeless

   (See figure in printed edition.)


--------------------
\1 U.S.  Department of Housing and Urban Development, A Report to the Secretary
on Homeless and Emergency Shelters (Washington, D.C.:  Office of Policy
Development and Research, 1984). 

\2 Martha R.  Burt and Barbara S.  Cohen, America's Homeless:  Numbers,
Characteristics, and Programs That Serve Them (Washington, D.C.:  The Urban
Institute, 1989).  The Urban Institute is a nonprofit policy research and
educational organization established in Washington, D.C., in 1968. 


   MCKINNEY ACT PROGRAMS AND FUNDING
-------------------------------------------------------------------- Chapter 1:1

Enacted in July 1987 and subsequently reauthorized in 1988, 1990, and 1992, the
Stewart B.  McKinney Homeless Assistance Act (P.L.  100-77) represents the
primary federal effort to provide homeless individuals and families in the
United States with shelter and related support services.  The McKinney Act
acknowledged that because of record increases in the number of homeless people,
states, localities, and private voluntary organizations had been unable to meet
the basic needs of the homeless, and greater federal assistance was warranted. 
Recognizing the diverse needs of the homeless population, the act and
subsequent amendments have funded programs designed to (1) provide emergency
food and shelter, (2) provide longer-term housing and supportive services when
needed to help people move toward independent living, and (3) develop and test
new approaches to assist homeless people more effectively.  The various
McKinney Act programs have also sought to strengthen and supplement existing
local programs, encourage cooperation and coordination of local service
delivery efforts, and stimulate nonfederal funding of programs and services. 

Since the act's enactment, new programs have been added, some programs have
been consolidated, and several programs have been eliminated.  Table 1.1 lists
the McKinney Act programs as of October 1992, by four categories of
assistance--food and shelter, health, employment, and education.\3 These
McKinney Act programs were administered at the federal level by five
departments--HUD, Health and Human Services (HHS), Veterans Affairs (VA),
Labor, and Education--and by FEMA.  Table 1.1 also identifies the federal
agency that administered each program. 



                                    Table 1.1
                     
                      McKinney Act Programs, by Category of
                              Assistance (Oct. 1992)

                                                      Department      Method of
                                                      or agency       funding
----------------------------------------------------  --------------  ----------
Food and shelter

Emergency Community Services Homeless Grant Program   HHS             Formula
(EHP)

Emergency Food and Shelter Program (EFSP)             FEMA            Formula

Emergency Shelter Grants (ESG)                        HUD             Formula

Rural Homeless Housing Assistance (RHHA)\a            HUD             Formula

Safe Havens\a                                         HUD             Formula

Section 8 Moderate Rehabilitation Program for         HUD             Grant
Single-Room Occupancy Dwellings for Homeless
Individuals (SRO)

Shelter Plus Care (S+C)                               HUD             Grant

Supportive Housing Program (SHP)\b                    HUD             Grant

Health

Research Demonstration Projects for Alcohol and Drug  HHS             Grant
Abuse Treatment of Homeless Persons (ADAT)\c

Community Mental Health Services Demonstration        HHS             Grant
Projects for Homeless Individuals Who Are
Chronically Mentally Ill (CMHS)\c

Domiciliary Care for Homeless Veterans (DCHV)         VA              Grant

Health Care for the Homeless (HCH)                    HHS             Grant

Health Care for the Homeless Children Demonstration   HHS             Grant
Program (HCHCDP)

Health Care for Homeless Veterans (HCHV)\d            VA              Grant

Homeless Families Support Services (HFSS)             HHS             Grant

Projects for Assistance in Transition from            HHS             Formula
Homelessness (PATH)

Employment

Homeless Veterans Reintegration Projects (HVRP)       Labor           Grant

Job Training for the Homeless (JTH)                   Labor           Grant

Education

Adult Education for the Homeless (AEH)                Education       Grant

Education for Homeless Children and Youth (EHCY)      Education       Formula
--------------------------------------------------------------------------------
\a The Congress authorized but did not appropriate funds for this program. 

\b Consists of previously separate programs--the Supportive Housing
Demonstration Program (transitional housing and permanent housing for the
handicapped) and the Supplemental Assistance for Facilities to Assist the
Homeless (SAFAH) program. 

\c Funding for these programs was consolidated into Access to Community Care
and Effective Services and Support. 

\d In February 1992, a number of health programs serving veterans, including
the Homeless Chronically Mentally Ill Veterans (HCMI) program, were
collectively renamed the Health Care for Homeless Veterans (HCHV) program. 

Local communities receive McKinney Act funds from the federal government in two
ways.  Under some programs, local jurisdictions are "entitled" to receive funds
allocated through a formula; under other programs, local jurisdictions compete
nationally for funds.  In some programs, funds go directly to cities or local
boards; in others, funds are passed down through state governments.  Some
competitive programs allow local nonprofit assistance organizations to apply
directly for funds.  In addition, each of the McKinney Act programs has it own
application process. 

During fiscal years 1987-93, funding for McKinney Act food and shelter programs
increased significantly, while funding for other major categories of McKinney
program assistance (health, education, and employment) changed little.  (See
fig.  1.2.) The food and shelter programs accounted for about 73 percent of the
total McKinney program funds during this period.  Health, education, and
employment programs together accounted for the remaining 27 percent of the
total McKinney program funds. 

   Figure 1.2:  McKinney Act Program
   Funds, by Category of Assistance,
   Fiscal Years 1987-93, in 1987
   Dollars

   (See figure in printed edition.)

\a Includes primary health care, mental health services, and treatment for
alcohol and substance abuse. 

During this period, funding for emergency food and shelter programs remained
relatively constant, while funding for nonemergency food and shelter
programs--the Supportive Housing (transitional housing), Section 8 Moderate
Rehabilitation for Single Room Occupancy Dwellings (SRO), and Shelter Plus Care
programs--has sharply increased.  (See fig.  1.3.)

   Figure 1.3:  Levels of Funding for
   McKinney Act Emergency and
   Nonemergency Food and Shelter
   Programs, Fiscal Years 1987-93, in
   1987 Dollars

   (See figure in printed edition.)

\a Emergency programs:  Emergency Community Services Homeless Grant Program,
Emergency Food and Shelter Program, and Emergency Shelter Grants. 

\b Nonemergency programs:  Section 8 Single-Room Occupancy Dwellings, Shelter
Plus Care, and Supportive Housing Demonstration Program (including Supplemental
Assistance for Facilities to Assist the Homeless). 

Funds authorized by the McKinney Act have not been fully appropriated.  For
fiscal years 1987-93, the Congress authorized about $5.6 billion ($4.9 billion
in 1987 dollars) and appropriated about $4.2 billion ($3.7 billion in 1987
dollars) for McKinney Act programs.\4 Even if funded at the authorized levels,
the McKinney programs would probably be able to provide benefits for only a
fraction of the hundreds of thousands estimated to be homeless already and
would help few of those who are at imminent risk of becoming so. 

Because so many agencies are involved in administering the McKinney Act
programs, the act also created and authorized funds for an Interagency Council
on the Homeless as an independent organization within the executive branch to
oversee federal programs for the homeless and to coordinate the delivery of
funds and services to those in need.  The McKinney Act requires the Interagency
Council to review all federal activities and programs to assist the homeless;
reduce duplication of effort; monitor, evaluate, and improve programs; provide
technical assistance to states, local governments, and private and nonprofit
organizations; collect and disseminate information; and prepare an annual
report to the President and the Congress. 

Members of the Interagency Council have included the heads of all 12 Cabinet
departments (or their designees), the heads of FEMA, ACTION (the federal
volunteer agency), the General Services Administration (GSA), and the Postal
Service; and the heads of other federal entities as determined by the
Interagency Council, such as a designee from the Office of Management and
Budget.  The daily operating activities of the Interagency Council have been
managed by an Executive Director.  In addition to a headquarters staff in
Washington, D.C., the Interagency Council also has had full-time field
coordinators.  Although the Interagency Council is authorized until September
30, 1994, no funds were appropriated for its operations for fiscal year 1994. 
On November 16, 1993, the Secretary of HUD and the Assistant to the President
for Domestic Policy announced that the Interagency Council would continue as a
working group under the Domestic Policy Council.  The Secretary of HUD also
announced that HUD would staff and fund this working group.  According to HUD's
Deputy Assistant Secretary for Economic Development, the working group retained
all of the Interagency Council's staff, was being funded by HUD, and would
continue many of the Interagency Council's responsibilities. 

In addition to McKinney Act programs, a wide variety of mainstream programs,
which are targeted to the general population low-income people, can be used to
assist the homeless.  These include programs administered by HUD; HHS; the
Departments of Agriculture, Education, Labor, and Veterans Affairs; and by
other federal, state, and local agencies.  In various ways, these programs
subsidize the cost of housing, supplement income, or provide food and a variety
of social services to low-income people.  Section 8 rent subsidies, public
housing, Supplemental Security Income, Aid to Families with Dependent Children,
Medicare, and food stamps are examples of assistance provided through
mainstream programs. 


--------------------
\3 Table 1.1 excludes two indirect programs not covered in our review:  the
Excess and Surplus Real Property Program and the Surplus Federal Personal
Property Donation Program.  The McKinney Act added providers of assistance to
the homeless to the list of entities eligible to acquire property no longer
needed by the federal government through these ongoing property disposition
programs.  Funding has not been authorized for either program, and
appropriations have not been made specifically to assist the homeless through
the programs.  Management of the real property program is shared by the General
Services Administration (GSA), HUD, and HHS.  The personal property program is
administered solely by GSA. 

\4 To show the decline in the purchasing power of McKinney Act funds, some
figures show what these funds could have purchased in 1987. 


   OBJECTIVES, SCOPE, AND METHODOLOGY
-------------------------------------------------------------------- Chapter 1:2

As requested by the Chairman of the Subcommittee on Housing and Urban Affairs,
Senate Committee on Banking, Housing and Urban Affairs, we reviewed efforts to
assist the homeless in selected cities to determine (1) what difference the
McKinney Act programs have made in addressing homelessness, (2) what problems
the cities have experienced with McKinney Act programs, and (3) what direction
the cities' programs for the homeless are taking and what gaps the McKinney Act
programs may fill.  We judgmentally selected four midsized cities with
populations under 1 million:  Baltimore, Maryland; San Antonio, Texas; Seattle,
Washington; and St.  Louis, Missouri.  We selected these cities to obtain
variation in demographic characteristics, in economic factors such as
unemployment and the poverty rate, and in the estimated homeless population. 
Table 1.2 summarizes this information. 



                          Table 1.2
           
            Selected Characteristics of Case Study
                            Cities

                                         San  Seattl     St.
Citywide statistics    Baltimore     Antonio       e   Louis
--------------------  ----------  ----------  ------  ------
Population               736,000     936,000  516,00  397,00
                                                   0       0
Demographics\a
White                        39%         36%     74%     50%
African-American             59%          7%     10%     47%
Hispanic                      1%         56%      4%      1%
Asian                         1%          1%     11%      1%
Other                                             1%
Unemployment rate,          7.3%        8.0%    6.1%    7.0%
 1992
Poverty rate, 1990         21.9%       22.6%   12.4%   24.6%
Estimated homeless        12,000       6,625  14,000  10,000
 population per
 year\b
------------------------------------------------------------
\a Some percentages may not add to 100 percent because of rounding. 

\b Counts of the homeless represent estimates made by the cities and are
generally used by the cities for planning.  We did not independently verify
these estimates.  The estimate for St.  Louis probably underestimates the
homeless population, since the primary system to count homeless people in the
city includes only those seeking shelter through the city's Housing Resource
Center.  This facility does not count many homeless men who use shelters
outside this system. 


      CITY PROFILES
------------------------------------------------------------------ Chapter 1:2.1

Baltimore is an older East Coast city that has lost jobs in recent years,
especially higher-paying, manufacturing jobs.  Baltimore city officials
estimate that about 77 percent of the homeless are minorities.  One study found
that approximately three-fourths of the homeless men and more than one-third of
the homeless women in Baltimore had substance abuse disorders and just under
half of both groups were mentally ill.\5 The city's Comprehensive Housing
Affordability Strategy (CHAS) estimated that about 100,000 people are at risk
of becoming homeless. 

San Antonio is a southwestern city, highly dependent on tourism and the defense
industry for employment.  City officials estimate that families make up a high
percentage of San Antonio's homeless population (52 percent).  Minorities make
up the largest portion of the homeless population.  City officials further
estimate that 6,625 people are homeless per year.  Inclusion of persons living
at risk in inappropriate housing or doubled up in dwellings designed for a
single family or individual would increase the estimate to about 11,000 to
13,000. 

According to officials, Seattle is the regional economic center for the Pacific
Northwest.  Officials expect employment to grow in the retail and service
sectors as manufacturing jobs are lost in the defense and commercial aviation
industries.  Single men make up the largest group of homeless people,
representing 45 percent of the homeless population.  Seattle officials estimate
that minorities comprise about 60 percent of the homeless people in shelters
and that at least 2,000 youth who are on their own are homeless over the course
of a year.  Over 36 percent of all people entering Seattle's emergency shelter
system are estimated to be from out of state. 

St.  Louis is a regional transportation hub for the Midwest.  It has a rapidly
growing convention industry that is replacing some lost higher-paying, blue
collar jobs, but at a much lower rate of pay.  Experts estimate that the
homeless population in shelters in St.  Louis includes large numbers of
minorities, individuals with substance abuse problems, and persons who are
mentally ill. 


--------------------
\5 William R.  Breakey, et al., "Health and Mental Health Problems of Homeless
Men and Women in Baltimore," Journal of the American Medical Association, Vol. 
262, No.  10 (Sept.  8, 1989), pp.  1352-1357. 


      METHODOLOGY
------------------------------------------------------------------ Chapter 1:2.2

We used a case study approach to determine what difference the McKinney Act
programs have made in the four cities.  In doing so, we attempted to identify
the total range of programs to assist the homeless in each location--those
administered by federal, state, and local government agencies, as well as those
administered by private, principally nonprofit, organizations.  Throughout this
report, the term "city" refers to all local groups and persons acting on behalf
of the homeless, not just to the city government. 

Our case study approach relied on three principal techniques:  individual
interviews (more than 200) with a wide range of local people involved in
assisting the homeless, focus groups (11) with providers of McKinney-funded
services to the homeless, and a conference of local experts in each city.  From
these sources, we developed an inventory of local programs for the homeless in
each city and a history of key events in each city's provision of services.  We
attempted to identify the total funds from various sources used to assist the
homeless in each city, but our data were incomplete.  We could not determine
with certainty the total funds targeted to assist the homeless or the exact
percentage represented by McKinney program funds in any assistance category
because complete inventories of service providers from which we could develop a
sampling methodology did not exist in all four cities.  We therefore relied on
data that were readily available or were provided incompletely by providers and
funding agents we contacted.  We cannot exclude the possibility that in some
instances the availability of McKinney program funds may have led local
officials to substitute these funds for funds from other sources. 

To determine what problems the cities have experienced with the McKinney Act
programs, we conducted interviews, held focus group discussions with service
providers administering the programs, and interviewed federal and local
government agency officials.  To determine what direction the cities' programs
are taking and what gaps the McKinney Act programs may fill, we relied on
interviews with local officials and discussions of this topic at the conference
of local experts held in each city.  We also reviewed available studies and
publications in order to place these comments in a national perspective. 
Additionally, we interviewed several homeless individuals or families in each
location to obtain clients' perspectives on the types of services available to
them. 

We developed our conclusions by triangulating evidence from multiple data
sources and multiple research methods.  Triangulation is a method employed in
the social sciences to enhance the credibility or validity of qualitative data,
like the data collected in the present study.  It requires that conclusions
drawn from data developed with one methodology or data source be confirmed by
one or more additional measurement processes. 

In this study, the multiple data sources included service providers and local
government officials in the areas of food, housing, health, mental health,
education, employment, and justice; advocates for the homeless; researchers;
and federal agency officials at the Departments of HUD, HHS, VA, Labor, and
Education and at the National Institutes of Health.  The research methods
included a cumulative case study design, which was used to develop evidence on
local perspectives from four different cities; semi-structured interviews that
were transcribed and content-coded for electronic analysis; focus group
discussions and content analysis of discussion transcripts; literature and
document reviews; qualitative analysis of key event histories; and hermeneutic
circles (a method of synthesizing various stakeholders' interpretations of the
same events). 

Our review focused on those findings and issues that met our professional
standards for validity and reliability.  We have omitted discussion of many
other issues and outcomes because they were specific to one city or discipline
(such as health) or did not meet our standards for validity. 

In addition, we discussed our methodology and obtained comments on a draft of
this report from two independent consultants who are nationally recognized
experts on homelessness. 

We performed our work between November 1991 and March 1994 in accordance with
generally accepted government auditing standards.  As requested, we did not
obtain written agency comments on a draft of this report.  However, we did
discuss our findings and draft recommendations with the Deputy Assistant
Secretary for Economic Development, HUD; the Deputy Assistant Secretary for
Program Systems in the Office of the Assistant Secretary for Planning and
Evaluation, HHS; the Associate Director, Policy and Operations, Mental Health
and Behavioral Science Services, VA; the Chief of Adult and Literacy Research
and Demonstration Programs, Department of Labor; a Senior Advisor in the
Division of Adult Education and Literacy, Department of Education; and the
former Executive Director of the Interagency Council on the Homeless.  These
officials generally agreed with our findings and draft recommendations, and we
have incorporated their comments where appropriate. 


MCKINNEY ACT PROGRAMS ENHANCE LOCAL
EFFORTS TO ASSIST THE HOMELESS
====================================================================== Chapter 2

All four case study cities offered a range of services to the homeless before
the McKinney Act was enacted; however, McKinney Act programs play an important
role by complementing and enhancing local efforts.  Although the cities obtain
funds for their programs for the homeless from many other sources, McKinney
program moneys have leveraged other funding, and, in some cities, represented a
major source of funds for various projects.  Our analysis of local efforts to
assist the homeless showed that McKinney programs helped one or more of these
four cities expand previously existing emergency services, test methods of
assisting people who are mentally ill or have substance abuse problems, and
develop new projects to address identified needs for transitional housing and
for employment and education services.  Some local service providers also
credit McKinney programs with encouraging the coordinated delivery of services. 


   LOCAL EFFORTS TO ASSIST THE HOMELESS
   PREDATE MCKINNEY ACT PROGRAMS
-------------------------------------------------------------------- Chapter 2:1

All four case study cities had been providing emergency food and shelter for
needy people, including the homeless, for many years before the McKinney Act's
enactment.  These efforts were funded by missions, churches, and private
groups, such as the Salvation Army.  Targeted programs largely served homeless
single males.  However, as the homeless populations in the cities grew and
changed to include more families, especially single women with children and
mentally ill persons, local programs evolved, providing a wider range of
services to meet the multiple needs of this diverse group. 

In response to these changes in the homeless population, the cities developed
different levels of activity and types of programs.  During this same period,
state and local governments provided limited funding.  Before the McKinney
Act's enactment, Seattle, with its social service orientation and strong
coalition of local service providers, worked diligently to establish and
coordinate programs for the homeless, incorporating services beyond emergency
shelter in its efforts.  Similarly, before the act's enactment, Baltimore
expanded the number and types of shelters and food programs it offered and
stepped up advocacy activities to draw public attention to the needs of the
homeless.  Major research efforts were also under way on the demographics and
physical and mental health needs of homeless people in Baltimore. 

Although organizations in St.  Louis had been providing some emergency services
over the years, the city government increased its efforts after a lawsuit was
decided against it in 1985.  To resolve the lawsuit, the city agreed to create
200 emergency shelter beds, place 100 families in permanent housing, and
appropriate funds each year for services to the homeless.  Of the four case
study cities, San Antonio had the fewest programs to assist the homeless before
the McKinney Act was enacted.  The city government had, however, been working
with a coalition of churches to provide emergency shelters and some other
services, such as health care, to the city's growing homeless population. 
Appendix I highlights some key events we identified in the evolution of
services for the homeless in the case study cities both before and after the
enactment of the McKinney Act. 


   MCKINNEY ACT PROGRAMS PROVIDE A
   RELATIVELY SMALL BUT IMPORTANT
   SOURCE OF FUNDS
-------------------------------------------------------------------- Chapter 2:2

By October 1992, the case study cities had developed a number of efforts to
assist the homeless.  Table 2.1 shows the number we identified in each city by
category of assistance. 



                          Table 2.1
           
            Efforts to Assist the Homeless in Case
           Study Cities, by Category of Assistance
                         (Oct. 1992)


Category of                              San  Seattl     St.
assistance             Baltimore     Antonio       e   Louis
--------------------  ----------  ----------  ------  ------
Food and shelter
------------------------------------------------------------
Emergency shelters            33          10      43      34
Transitional housing          30           3      29      10
 projects
Permanent/                     2           0       7       2
 handicapped housing
 projects
McKinney single room           0           1       4       0
 occupancy (SRO)
 projects
Food banks and hot           175         175      64      38
 meal programs\a

Health
------------------------------------------------------------
Health programs               12           3       6       8

Employment
------------------------------------------------------------
Employment programs            3           1       3       4

Education
------------------------------------------------------------
Education programs             5           1       3       2
------------------------------------------------------------
Note:  Although we attempted to identify all efforts in these four categories
targeted specifically to serve homeless people in each city, we relied heavily
on existing records and key officials.  As a consequence, we may have
inadvertently omitted some small programs operated by private organizations,
such as churches.  Also, cities' efforts to prevent homelessness are not
reflected in this table. 

\a The food programs, while serving the homeless, also serve others in need. 
Not included are meal programs operating in the shelters. 

Figure 2.1 illustrates typical shelters for the homeless in the four cities. 



(See figure in printed edition.)Figure 2.1:  Typical Variety of Shelter
Facilities Available in the Four Cities

Baltimore



(See figure in printed edition.)San Antonio



(See figure in printed edition.)Seattle



(See figure in printed edition.)St.  Louis

To help support these efforts, the cities participated in from 10 to 13
McKinney Act programs.  Table 2.2 lists the McKinney Act programs that were
operating in one or more of the cities. 



                                    Table 2.2
                     
                      McKinney Act Programs Operating in the
                             Four Cities (Oct. 1992)


                                                         San                 St.
Program category and name              Baltimore     Antonio   Seattle     Louis
------------------------------------  ----------  ----------  --------  --------
Food and shelter
--------------------------------------------------------------------------------
Emergency Community Services                   X           X         X         X
 Homeless Grant Program (EHP)
Emergency Food and Shelter Program             X           X         X         X
 (EFSP)
Emergency Shelter Grants (ESG)                 X           X         X         X
Section 8 Moderate Rehabilitation                          X         X
 Program for Single-Room Occupancy
 Dwellings for Homeless Individuals
 (SRO)
Supplemental Assistance for                    X                     X         X
 Facilities to Assist the Homeless
 (SAFAH)
Supportive Housing Demonstration               X           X         X         X
 Program (SHDP)

Health
--------------------------------------------------------------------------------
Research Demonstration Projects for                                  X         X
 Alcohol and Drug Abuse Treatment of
 Homeless Persons (ADAT)
Community Mental Health Services               X
 Demonstration Projects for Homeless
 Individuals Who Are Chronically
 Mentally Ill (CMHS)
Health Care for the Homeless (HCH)             X           X         X         X
Homeless Chronically Mentally Ill              X           X                   X
 Veterans (HCMI)
Projects for Assistance in                     X           X         X         X
 Transition from Homelessness (PATH)

Employment
--------------------------------------------------------------------------------
Homeless Veterans Reintegration                            X         X         X
 Projects (HVRP)
Job Training for the Homeless (JTH)                                  X         X

Education
--------------------------------------------------------------------------------
Adult Education for the Homeless               X           X         X         X
 (AEH)
Education for Homeless Children and            X
 Youth (EHCY)
Education for Homeless Children and            X                     X
 Youth--Exemplary Grants\a
================================================================================
Total program participation                   12          10        13        12
--------------------------------------------------------------------------------
\a Grants were funded under this program in fiscal year 1990 only.  In fiscal
year 1991, funds for this program were allocated from the funding authorized
for EHCY, a 2-year grant program. 

All of the cities received funds from entitlement emergency food and shelter
programs, such as FEMA's Emergency Food and Shelter Program (EFSP) and HUD's
Emergency Shelter Grants (ESG) program.  These programs allocate money to
communities on the basis of a formula.  The cities differed, however, in the
number of competitive McKinney Act programs for which they were selected to
participate.  For example, two of the four cities had SRO projects, two cities
had research demonstration programs for alcohol and drug abuse, and two cities
had job training programs.  Three cities had three of the McKinney Act programs
that provide mental health services, while one city, Baltimore, had all four. 
Additionally, while all of the cities received McKinney program funds for
transitional housing, Seattle received by far the largest amount--enough to
support 24 projects. 

McKinney program moneys constituted a small but important portion of the
cities' overall funds for assisting the homeless.  Although we were not able to
determine how much money from non-McKinney sources was targeted to help the
homeless, we concluded from available information that McKinney moneys
represented a small portion of the overall funds for food, shelter, and health
care in all four cities.  They were, however, a major resource for education
and employment efforts, few of which had been targeted to assist the homeless. 
McKinney funding levels over the act's first 5-year period (1987-91) for the
four case study cities ranged from a low of $12.9 million in San Antonio to a
high of $37.3 million in Seattle.  Table 2.3 shows McKinney program funding in
the four cities, by category of assistance. 



                                    Table 2.3
                     
                        McKinney Program Funds in the Four
                     Cities, by Category of Assistance (1987-
                                       91)

Category of
Assistance             Baltimore     San Antonio         Seattle       St. Louis
----------------  --------------  --------------  --------------  --------------
Food and             $12,501,503     $10,376,195     $28,948,396    $ 10,178,120
 shelter\a                 (65%)           (80%)           (78%)           (53%)
Health\b               6,526,888       2,289,644       5,542,947       8,031,036
                           (34%)           (18%)           (15%)           (43%)
Employment                0 (0%)    195,000 (1%)  2,291,718 (6%)    596,457 (3%)
Education           240,190 (1%)     67,000 (1%)    484,749 (1%)    231,388 (1%)
================================================================================
Total                $19,268,581     $12,927,839     $37,267,810     $19,037,001
                          (100%)          (100%)          (100%)          (100%)
--------------------------------------------------------------------------------
\a Includes emergency food and shelter, transitional housing, SAFAH, and
Permanent Housing for Handicapped Homeless Persons (a component of SHDP). 

\b Includes primary health care, mental health services, and alcohol and
substance abuse treatment. 

Non-McKinney funds for programs to assist the homeless in each city came from
private sources and other public sources, including city general funds, state
funds, and federal Community Development Block Grant (CDBG) funds.  Seattle
provided additional assistance through a $50 million housing levy program
directed toward housing for low-income and homeless people with special needs,
while San Antonio established a housing trust fund.  Maryland collected local
funds from marriage license fees for two Baltimore shelters that provide
services for victims of domestic violence.  Private funding sources included
organizations such as churches, foundations, and the United Way, as well as
private individuals, private industry, and professional associations. 

For emergency food and shelter services, the private sector--especially
churches, foundations, and private citizens--was the main source of funds in
all four cities.  For example, in Baltimore, one church organization reported
that its private contributions alone exceeded the funds for McKinney emergency
food and shelter programs in fiscal year 1991.  In St.  Louis, individual
and/or corporate donations greatly exceeded the funding for McKinney emergency
food and shelter programs, according to tax credit data provided by the state
of Missouri.  One private source in San Antonio, the United Way, contributed as
much as McKinney programs for emergency food and shelter.  The United Way's
funding for San Antonio's programs steadily increased from about $791,000 in
1987 to $1.1 million in 1991. 

Officials in all four cities told us that McKinney program moneys in the health
category, though small, were significant because they funded on-site and
outreach efforts that helped link homeless people to the primary health care
service system.  As the following examples show, McKinney programs were not the
primary source of funds for health care for the homeless.  The state of
Maryland contributed more in Baltimore than McKinney programs for primary
health care (not including health research grants), mental health services, and
substance abuse services.  The director for a large project serving mentally
ill homeless people in Seattle estimated that only $11,000 of his $1.3 million
budget came from McKinney program funds. 

In Seattle, San Antonio, and St.  Louis, McKinney dollars were a primary source
of funds in the education and employment categories.  For example, in 1991,
McKinney dollars represented the largest portion of the funds for Seattle's
largest employment program targeted to assist the homeless.  McKinney dollars
were also a major source of funds for providing employment services to homeless
veterans in the three cities.  An adult literacy program operating at 14
shelters in 1990-91 in Seattle was supported almost entirely by McKinney funds,
while literacy programs targeting homeless people in San Antonio and St.  Louis
were fully funded by McKinney dollars.  In contrast to the other three cities,
Baltimore received no McKinney funds for employment and training programs for
the homeless.  One of its three local programs is funded by the federal Job
Training Partnership Act (JTPA) program, another is sponsored by a church, and
a third is sponsored by local businesses.  Although Baltimore received McKinney
education funds through state government grants, the sum for programs for
adults and children was smaller in 1992, for example, than the amount
contributed to homeless students by the city's Department of Education
Services. 


      MCKINNEY ACT PROGRAMS HELPED
      LEVERAGE OTHER FUNDS
------------------------------------------------------------------ Chapter 2:2.1

While McKinney program funds were often small in comparison with funds from
other sources, officials in all four cities told us that McKinney programs play
an important role by leveraging other funding.  Service providers told us that
McKinney funds add legitimacy to their programs and enable them to generate
other funds.  One shelter provider in San Antonio stated that McKinney programs
have provided seed money that stimulated funding from other sources.  After the
San Antonio shelter had received an initial McKinney grant of $39,000 for
renovation, for example, a charitable foundation was willing to donate to the
ongoing project.  A shelter provider in Baltimore said that McKinney funds are
regularly used to attract other funds.  According to the provider, private
foundations are more willing to donate funds to a project once they know that
it received funding from the federal government.  In St.  Louis, one service
provider told us that McKinney funds were primarily responsible for a local
bank's giving the shelter a loan to complete renovations on a housing facility
for those who become homeless because of AIDS.  A local Seattle employment
official stated that "McKinney Act resources have been the glue that has
garnered significant local and state resources to attack the homeless problem
locally."

According to local experts, McKinney programs also helped educate the public
and raise awareness in the communities, attracting interest and other funds,
and helped some providers establish a track record for administering programs
for the homeless.  The Maryland State Coordinator of Education for Homeless
Children and Youth stated that McKinney programs heightened local awareness of
education problems and impressed on the state the need to work with shelters
and social service organizations. 


   MCKINNEY ACT PROGRAMS STRENGTHEN AND
   SUPPLEMENT LOCAL PROGRAMS
-------------------------------------------------------------------- Chapter 2:3

Many positive results were credited to McKinney Act programs in our case study
cities.  All four cities were using McKinney emergency food and shelter
programs to supplement their local efforts.  Officials told us that McKinney
emergency programs helped increase the quantity and improve the quality of food
distributed to homeless clients, provided for the renovation of shelter
facilities, increased the number of shelter beds, and expanded support services
such as case management.  For example, one food assistance provider in San
Antonio credited McKinney programs with providing food to 20,000 additional
persons, almost doubling the number of people served.  McKinney programs also
allowed providers to upgrade the variety of food and include meat.  Another
organization in San Antonio credited McKinney programs with providing 15,870
additional emergency shelter bed nights in 1991.  A service provider in St. 
Louis told us that without the McKinney programs, many shelters would probably
have had to stop all case management and support services.  Also, there would
have been little or no utility and rental assistance to help prevent people
from becoming homeless. 

Some providers in each of the four cities credit McKinney programs with helping
them expand health services.  Of the 29 health programs targeted to the
homeless that we identified in the cities, most received some support from
McKinney programs.  Officials in three of the cities told us that McKinney
programs allowed them to continue and expand the on-site health assistance to
the homeless that they had begun to provide as initial recipients of the Robert
Wood Johnson Foundation's Health Care for the Homeless program.\1 In San
Antonio, Health Care for the Homeless, according to its executive director,
assisted approximately 2,000 individuals per year, including both at-risk and
literally homeless persons, before McKinney programs were put in place. 
Afterwards, under the McKinney programs, this agency was able to extend
assistance to approximately 9,000 individuals a year.  The executive director
believes that without the McKinney program this contact with homeless clients
would not have occurred.  A service provider in St.  Louis credited McKinney
programs with allowing his project to expand health services to respond to
substance abuse and AIDS, as well as to offer needed support services, such as
podiatry care, transportation to health facilities, and prescription
medications. 

Local officials said that McKinney programs expanded services to mentally ill
homeless people in each of the four cities because the programs allowed them to
reach out to those on the street.  Providers told us that outreach allows them
to offer needed services to homeless people who cannot gain access to other
community services because they are ill, fear the system, or have other
problems.  For example, in St.  Louis, under the McKinney Projects for
Assistance in Transition from Homelessness, mental health workers use a mobile
unit to search for and identify mentally ill people in need of services.  In
San Antonio, under the same McKinney program, outreach workers screen and
evaluate homeless people and teach the local police how to deal with the
mentally ill.  A mental health official told us that because of this training,
some local law enforcement officers now refer homeless people needing treatment
to mental health professionals rather than incarcerating them.  Similarly,
Baltimore used this McKinney program to expand mobile treatment services for
the homeless mentally ill, pay for a housing resource specialist to help locate
and develop affordable housing, implement a representative payee program in
which the provider helps mentally ill clients manage their money, and train
non-mental health professionals who work with mentally ill homeless people. 
Some providers stated that without these McKinney programs, some services,
including case management and outreach efforts, would be discontinued.  They
said that they would have to return to providing emergency services and would
not be able to offer the extra support needed to stabilize clients. 

Figure 2.2 shows some of the McKinney-funded services available in the four
cities to assist homeless clients. 



(See figure in printed edition.)Figure 2.2:  McKinney-Funded Services Available
in the Four Cities to Assist Homeless Clients

Feeding Program



(See figure in printed edition.)Health Facility



(See figure in printed edition.)Day Care



(See figure in printed edition.)Nursery


--------------------
\1 In 1985, the Robert Wood Johnson Foundation and the Pew Memorial Trust
awarded $25 million to establish Health Care for the Homeless demonstration
projects in 19 large U.S.  cities.  Each project was to provide an array of
services in community locations and facilities used by the homeless, such as
shelters, soup kitchens, and neighborhood centers. 


   MCKINNEY ACT PROGRAMS ENCOURAGE
   INNOVATION AND DEVELOPMENT
-------------------------------------------------------------------- Chapter 2:4

McKinney funds helped cities to test new ways of assisting homeless people with
special problems and to develop other needed programs, projects, and services. 
For example, McKinney programs initially funded demonstration and research
projects for homeless clients with substance abuse problems and mental illness. 
McKinney funding also supported the development of transitional housing
projects in two cities, employment programs in three cities, and adult
education programs for homeless people in all of the cities. 

Three of the cities designed new ways to assist people who had substance abuse
problems or were mentally ill.  For example, in Seattle providers offered
intensive case management to a very dysfunctional group of chronic inebriates
to determine whether such assistance made a difference in their quality of life
over the long term.  In St.  Louis, providers designed a project to help
homeless substance-abusing women with children.  The project supplements
traditional 60-day emergency shelter services with 12 months of case management
and/or comprehensive family and child development services.  Before this
project was started, there were no substance abuse programs in St.  Louis
designed specifically for homeless mothers.  Mental health providers in
Baltimore used the McKinney Community Mental Health Services Demonstration
Project for Homeless Individuals Who Are Chronically Mentally Ill (CMHS)
program to test the effectiveness of an Assertive Community Treatment Team
project for homeless people with severe mental illness.  The project is
designed to increase access to services and basic necessities through outreach
and case management and to improve mental health outcomes. 

McKinney programs also helped each case study city develop other needed
projects and programs.  For example, in its local Comprehensive Housing
Assistance Strategy, each city identified the need to develop transitional
housing for homeless people who need supportive services to leave the shelters,
find permanent housing, and lead independent lives.  Providers used the
McKinney Supportive Housing Demonstration Program to start 24 of 29
transitional housing projects in Seattle, 9 of 10 transitional projects in St. 
Louis, and a large multiservice center and shelter project in San Antonio. 
Additionally, the cities identified the need for permanent housing options. 
Five single room occupancy (SRO) projects (buildings consisting of one-room
dwelling units for single adults) and the permanent housing for the handicapped
projects identified in the four cities were developed under McKinney programs. 
Providers told us that some of these projects would not have been developed
without the McKinney programs. 

Before the McKinney Act's enactment there were virtually no education programs
specifically designed for homeless adults and children in the four cities.  In
all four cities, McKinney funding helped establish education programs for
homeless adults, and in two cities it helped establish programs for homeless
children.  The programs for adults have focused on enrolling clients in
literacy programs.  For example, in St.  Louis, a literacy project provides
outreach to clients in shelters through the McKinney Adult Education for the
Homeless program.  McKinney funding also established adult literacy programs in
Seattle at a number of sites.  At two local shelters in Baltimore, McKinney
funds supported a mentoring and education program that focused on basic life
skills and literacy and employability training.  In the same city, the
Education for Homeless Children and Youth program has provided a place to study
after school, on-site tutoring, assistance with homework, and cultural
enrichment activities for children living in nine family shelters. 

Officials in San Antonio and St.  Louis credit a McKinney program with
establishing their employment services for homeless veterans.  When an
organization in San Antonio lost a McKinney employment training program for
veterans, services ceased.  In Seattle, providers used McKinney funds to expand
employment services for homeless men and women at 22 shelters.  A local study
indicated that these were the first on-site services available at Seattle
shelters to assess participants' employability. 


   MCKINNEY ACT PROGRAMS ENCOURAGE
   COOPERATION AND COORDINATION OF
   LOCAL SERVICES
-------------------------------------------------------------------- Chapter 2:5

Although some organizations and local government agencies assisting the
homeless had well-established networks for sharing information and delivering
services before the McKinney Act's enactment, some providers in all four cities
credit McKinney Act programs with bringing together local organizations and
bureaucracies that might not otherwise have interacted.  The criteria for
awarding grants for some of the competitive McKinney grant programs, for
example, give points for establishing linkages to other programs.  A Seattle
service provider said the McKinney employment program that provides funds to
his organization requires grant recipients to collaborate with other providers
of social services, so that people who might not otherwise interact with one
another (e.g., employment counselors, shelter operators, and housing authority
officials) are brought together.  Furthermore, McKinney programs helped
employment officials pull together diverse shelter, health care, housing,
employment, training, and other critical services to implement a comprehensive
service system for the homeless. 

A St.  Louis provider told us that because the McKinney Act supports a wide
range of services, many agencies are involved in providing services and
referring homeless persons to other needed services.  City officials in San
Antonio credited McKinney Act programs with helping the city focus on
priorities for assistance and better coordinate efforts.  A provider in
Baltimore felt that funding for the Community Mental Health Services research
demonstration grant encouraged collaboration among the shelters, primary health
care providers, local mental health authorities, universities, and advocacy
groups.  On the research side, he said that McKinney programs had established a
previously nonexistent collaboration of researchers across disciplines
(psychiatry, social work, anthropology, and economics) and across universities. 
However, some providers believed that the competitive nature of many of the
McKinney programs and the fragmented administration of the programs on the
federal level impede the coordination of service delivery on the local level. 


   CONCLUSIONS
-------------------------------------------------------------------- Chapter 2:6

Our study of McKinney Act programs in four cities shows that these programs
strengthened and supplemented existing local efforts to assist the homeless by
enabling providers to expand emergency food, shelter, and health services.  The
McKinney programs also gave communities the opportunity to test new approaches
for assisting homeless people suffering from mental illness or substance abuse
problems.  Besides increasing the total assistance available from public and
private sources, the McKinney programs helped to leverage funds from other
contributors.  In addition, the programs improved the coordination of services
for the homeless by bringing together providers and officials who had not
worked together before. 


PROVIDERS SAY SOME POLICIES AND
REQUIREMENTS MAKE MCKINNEY ACT PROGRAMS
DIFFICULT TO MANAGE
====================================================================== Chapter 3

While service providers in all four cities attributed many positive results to
McKinney Act programs, as described in chapter 2, they expressed
dissatisfaction with some aspects of the programs.  Some providers questioned
program policies that they believe make it more difficult for them to develop,
provide, and maintain adequate services for homeless clients.  A major concern
was the emphasis in McKinney programs on demonstrating new approaches without
providing for the continued support or expansion of successful approaches. 

Federal officials acknowledge that requests for competitive grants greatly
exceed available funds and that only a small percentage of applicants receive
funds for McKinney Act demonstration and research programs.  The officials told
us that a key role of many McKinney programs is to identify new and better
methods of dealing with the multiple problems of homeless people and to
disseminate information on what works.  We found that evaluations of many
McKinney programs are being conducted to obtain information on what works. 
However, there are no plans to consolidate and disseminate this information to
those outside each individual federal agency's normal constituency who might
also find the information useful.  Furthermore, according to federal officials,
funds to implement methods that work must come from other sources. 

Additionally, some providers expressed concerns about administrative issues
that made it difficult for them to manage multiple programs--principally
burdensome application procedures and record-keeping requirements.  We found
that the Congress and some agencies have taken actions designed to partially
alleviate the administrative concerns.  However, some federal officials believe
that more uniform reporting requirements or some form of program consolidation
may still be needed. 

Because the federal Interagency Council on the Homeless was authorized by the
Congress to, among other things, reduce the duplication of efforts in federal
programs for the homeless, provide technical assistance to localities, and
collect and disseminate information to the 12,000 people and organizations on
its mailing list, it would have been the logical entity to further address
duplicative administrative requirements and to widely disseminate the results
of McKinney Act program evaluations and demonstrations.  However, HUD's Deputy
Assistant Secretary for Economic Development told us that the Domestic Policy
Council's working group, created to replace the Interagency Council, had
retained all of the former Interagency Council's staff, was being funded by HUD
for fiscal year 1994, and would continue many of the activities previously
undertaken by the Interagency Council. 


   SERVICE PROVIDERS QUESTION SOME
   MCKINNEY PROGRAM POLICIES
-------------------------------------------------------------------- Chapter 3:1

While providers say that the McKinney Act created opportunities to complement
and enhance existing programs as well as develop new programs, some providers
in all four cities were concerned that their programs would not continue to
receive funding.  Also, because most of the McKinney programs provided funds to
grantees through competitive grants, not all applicants were awarded funds. 
Unsuccessful grant applicants raised concerns that they were missing out on
important program development opportunities. 


      PROVIDERS QUESTION SHORT-TERM
      NATURE OF MCKINNEY DEMONSTRATION
      PROGRAMS
------------------------------------------------------------------ Chapter 3:1.1

The majority of competitive grants were awarded to programs designed to
illustrate innovation and development, such as HUD's more than 700 transitional
housing grants.  Operators of McKinney-funded transitional housing projects
were particularly anxious about losing funding as their 5-year grants neared
expiration.  These providers were concerned that after learning what worked and
how best to meet the needs of their clients, they might not be able to continue
their efforts.\1

A small number of research grants were also awarded to test new methods for
meeting the needs of various groups of homeless people, including the mentally
ill and those with substance abuse problems.  For example, HHS' Research
Demonstration Projects for Alcohol and Drug Abuse Treatment of Homeless Persons
(ADAT) awarded only 23 grants over the life of the program (9 grants in 1988
and 14 grants in 1990).  The funds were used to implement and evaluate
successful and replicable approaches to community-based treatment and
rehabilitation services for homeless individuals who abuse alcohol and drugs. 
However, because of the experimental role of McKinney demonstration programs,
providers were concerned that they would not continue to receive support to
sustain or expand successful approaches. 


--------------------
\1 The Congress responded to the requests of transitional housing providers for
longer-term funding by allowing grants to be renewed under HUD's Supportive
Housing Program.  According to HUD officials, the funding for this program was
originally to have been phased out. 


      PROVIDERS SAY RESEARCH FUNDS THAT
      CAN PROVIDE CRITICAL SERVICES ARE
      NOT AVAILABLE TO THEM
------------------------------------------------------------------ Chapter 3:1.2

Providers also cited difficulties in obtaining research funds for services they
believed were critical to their organization.  Those who applied for but did
not receive grants were concerned that their communities were being left out of
developing new programs in vital service areas and were missing opportunities
to deliver needed services.  For example, a city official in Baltimore
explained that not getting funds for substance abuse treatment was significant
because awards were made only once every 3 years.  When Baltimore did not get
funded in the fourth year, it could not apply again for funds until the seventh
year.  Another provider indicated that the same problem existed under the
Department of Labor's Job Training for the Homeless demonstration program
grants, which are also awarded for 3 years.  Providers felt that not obtaining
the initial funding for these types of McKinney programs meant getting left out
for a long time. 


      FEDERAL OFFICIALS EMPHASIZE
      DEMONSTRATION AND INFORMATIONAL
      ROLE OF MCKINNEY ACT PROGRAMS
------------------------------------------------------------------ Chapter 3:1.3

Federal officials acknowledged that only a small percentage of applicants are
awarded program funds in most competitive McKinney Act programs.  According to
a HUD official, the agency gets over 1,200 applications annually for its
programs for the homeless and funds about 200 (about 16 percent).  Officials
from the Department of Labor told us that they received over 300 applications
for the Job Training for the Homeless demonstration program and funded a few
over 40 (about 13 percent).  VA officials told us that in 1993 they received
$80 million in proposals for $10 million in funding and believed that the
denied requests were as good as the funded ones.  An official from the
Department of Education told us that the Department changed its program to a
competitive system to give fewer but larger awards because the $50,000 grant
that each state originally received as an entitlement was too small to be of
much use. 

Federal program administrators told us that the McKinney research and
demonstration programs are not designed or funded to provide services on a
large scale.  Rather, these officials see McKinney programs as providing
opportunities for grantees to try new approaches to meet the special needs of
homeless people in a range of areas and to identify and disseminate information
on what works well. 

The Departments of HUD, HHS, VA, Labor, and Education have recently evaluated
or are currently evaluating a total of 11 McKinney Act programs.  (See app. 
II.) The completed evaluations are designed to identify

social, financial, and other impacts of transitional housing;

ways of providing community-based treatment and rehabilitation services for
homeless persons who abuse alcohol and drugs;

ways of providing coordinated housing, treatment, and supportive services for
homeless mentally ill persons;

ways of delivering health care; and

ways of providing employment and training to homeless people. 

Federal officials administering other demonstration and research projects for
the homeless told us that in the future they expect their McKinney programs to
play the same experimental role that they currently play and that there are no
plans or money to replicate successful programs. 

Federal officials also told us that they share information on successful
efforts formally at annual conferences and informally through site visits,
on-site monitoring, and conference calls.  However, the primary recipients of
this information are those receiving grants from individual federal programs,
so the information is reaching only a limited audience of current agency
constituents.  Other organizations may provide services to some of the same
clients but not be part of an agency's constituency.  For example, shelter
operators who serve veterans among other clients might learn significant
lessons from information on the McKinney programs for veterans but would not
necessarily receive routine information on these programs and their results
from VA. 


      COORDINATED FEDERAL EFFORTS ARE
      NEEDED TO BETTER DISSEMINATE
      PROGRAM EVALUATION RESULTS
------------------------------------------------------------------ Chapter 3:1.4

While officials from various federal agencies administering the McKinney Act
programs told us that they would disseminate information from successful
demonstrations so that others could learn from the projects, the means
suggested (conferences, newsletters, and other informal methods of
communication) do not ensure that interested providers operating programs
outside the individual agency's category of assistance will receive such
information. 

Communications about all agency programs used to be a function of the former
Interagency Council, which had a mailing list of 12,000 and conducted regional
conferences.  According to HUD's Deputy Assistant Secretary for Economic
Development, the Domestic Policy Council's new working group on the homeless
will continue the key functions of the Interagency Council.  She said that HUD
had retained all of the Interagency Council's staff and was funding the working
group's operations.  According to the Deputy Assistant Secretary, the new
working group has continued to communicate with the Interagency Council's
constituency through regular mailings of information about available funds and
changes in McKinney Act programs and through "interactive forums" in
communities. 


   PROVIDERS FOUND SOME MCKINNEY ACT
   PROGRAMS' ADMINISTRATIVE
   REQUIREMENTS BURDENSOME
-------------------------------------------------------------------- Chapter 3:2

Although the Congress and some agencies have taken a number of steps--such as
simplifying program procedures and expediting the disbursement of program
funds--to remove barriers to providers' use of the McKinney Act programs,
service providers in all four case study cities described problems in
administering some of the programs.  On the local level, many programs for the
homeless are administered by small nonprofit organizations that rely on a
number of funding sources to provide an array of services to meet their
homeless clients' many needs.  Such providers have found it difficult to meet
the application and record-keeping requirements of multiple McKinney programs. 


      PROVIDERS HAVE HAD DIFFICULTY
      ADMINISTERING MULTIPLE MCKINNEY
      PROGRAMS
------------------------------------------------------------------ Chapter 3:2.1

As discussed in chapter 2, the McKinney Act authorizes a wide range of programs
to help local governments and service providers meet the varied needs of
homeless people.  These programs are administered at the federal level by five
departments--HUD, HHS, VA, Labor, and Education--and by FEMA.  Each of the
McKinney programs has its own application process.  Some programs require
simple applications, while others call for longer, more detailed project
summaries and supporting exhibits.  Some programs require annual
reapplications.  Each program also has its own record-keeping requirements and
reporting schedules established by the agency.  Providers view these
requirements as particularly burdensome because McKinney programs are only one
of many funding sources that they rely on to support their services for the
homeless.  For example, in 1991, many of Seattle's 22 city-funded shelters
relied on as many as seven different funding sources.  A multiservice center in
San Antonio used 12 different funding sources, including 3 different McKinney
programs.  In Baltimore, in 1991, one shelter relied on at least 19 sources for
funding and another shelter relied on 17. 

In all four cities, McKinney program grantees described the process of applying
for some programs as complex and sometimes lengthy, taking scarce staff
resources away from serving homeless clients.  Some officials told us that they
needed to hire grant writers to compete successfully for McKinney program
funding.  Focus group participants in two cities described the application for
HUD's Shelter Plus Care program as lengthy and difficult.  For example, the
coordinator for the homeless in Baltimore stated that two full-time staff
worked for a month and more than half a dozen other coordinators and writers
worked many dozens of hours to complete the Shelter Plus Care application. 

Also, providers criticized the annual reapplication requirements of some
programs.  They stated that the short funding cycle of programs such as the Job
Training for the Homeless demonstration program does not allow enough time to
work with homeless clients with difficult problems.  In some instances,
providers may spend more time writing grants and identifying and applying for
matching funds than serving clients. 

Providers also discussed the difficulties they experienced in administering
programs with different documentation requirements.  According to some
providers, programs may call for much of the same information but require it to
be collected and reported in different formats.  For example, some programs
require forms for taking in, tracking each month, releasing, and following up
on clients.  Other programs require quarterly financial reports, information on
participants' outcomes and demographic data, and narrative reports on program
activities.  Additionally, while some programs call only for annual status
reports, others require interim performance reports, expenditure reports, and
preliminary and final evaluation reports.  Providers said that, in some
instances, the demands on staff to manage administrative requirements impede
the staff's providing quality service to a difficult-to-serve population.  One
staff administrator told us that the project's case manager spends
approximately one-third of the time coordinating the various documentation and
reporting requirements. 


      AGENCIES HAVE SIMPLIFIED SOME
      REQUIREMENTS, BUT OFFICIALS
      ACKNOWLEDGE THAT PROBLEMS REMAIN
------------------------------------------------------------------ Chapter 3:2.2

As the McKinney Act programs have evolved, the Congress and some agencies have
simplified the programs' administration.  Both GAO and the Office of Evaluation
and Inspection (OEI) within HHS' Office of Inspector General (OIG) previously
reported on barriers cited by providers in gaining access to McKinney
programs.\2 We found that since these reports were issued, fund allocation
formulas and matching requirements have been changed, electronic fund transfers
have been authorized to permit quicker disbursement of funds, and some
programs' guidelines and procedures have been simplified. 

Federal officials acknowledge that providers may still have difficulty
obtaining and managing funds from various agencies for their projects for the
homeless and that more could be done to simplify the administration of some
McKinney programs.  HUD officials, for example, concede that parts of the
Shelter Plus Care program application, especially the Section 8 SRO component,
are very complicated.  To simplify one aspect of the program, the Congress
authorized a single appropriation and HUD consolidated the administration
(previously different components were administered in different divisions
within HUD).  HUD also revised the application process. 

In fiscal year 1993, HUD further simplified the application procedures for its
programs by introducing a single Notice of Funds Availability (NOFA) for the
SRO, Shelter Plus Care, and Supportive Housing programs.  This notice gives
applicants a total funding picture for the year in advance.  A HUD official
told us that the agency tried to design one application package for all three
programs but was unable to do so because the programs differed so much from one
another.  HUD has, however, made the applications for the three programs
similar and now uses the same core rating criteria. 

Federal officials also acknowledged that the different reporting requirements
for the various programs created problems for grantees; however, they could not
suggest any ways of consolidating reporting requirements for the current
programs.  HUD officials indicated that past interdepartmental efforts to
standardize reporting requirements had failed because of differences in
congressional requirements for the type of recipient and the type of program,
as well as differences in the programs' fiscal years. 


--------------------
\2 Homelessness:  Access to McKinney Programs Improved but Better Oversight
Needed (GAO/RCED-91-29, Dec.  28, 1990) and State and Local Perspectives on the
McKinney Act (OEI-05-90-01090, Dec.  1990). 


      OFFICIALS DIFFER IN THEIR VIEWS
      ON CONSOLIDATING PROGRAMS
------------------------------------------------------------------ Chapter 3:2.3

Some federal and local government administrators and service providers believe
that consolidating some of the separate McKinney Act programs could reduce
these administrative problems.  Officials told us that from a local
perspective, consolidation would make life easier for grantees by reducing the
number of applications and other requirements, and from a federal perspective,
it would simplify program administration and save staff time.  Several options
for consolidating the programs have been suggested by service providers,
advocates for the homeless, and local government and federal agency officials. 
These options include (1) combining the programs by categories of assistance,
such as employment assistance; (2) consolidating the programs by category of
need, such as the need for mental health services; (3) establishing a single
grant for demonstration efforts; and (4) establishing a block grant for
services for the homeless to be administered by cities, states, or a local
board, as the FEMA program is currently administered. 

Supporters of an entitlement or block grant approach point out that the nature
and scope of homelessness varies across the country and that priorities for
delivering these services should be made at the state and local level rather
than at the federal level.  Funds could be distributed locally by the city
government or by a designated local nonprofit organization, which would serve
as a focal point in the community for coordination, planning, and evaluation. 

Other local and federal officials, however, do not support program
consolidation or the distribution of funds by formula.  Advocates of the
current mix of categorical programs assert that homeless people have special
needs that can best be handled by targeted services.  If money is not earmarked
at the federal level for such programs, these advocates say, the varied needs
of homeless people will be lost in competing demands for limited resources. 
Additionally, some service providers prefer applying directly to the federal
government for funds to avoid problems with local allocation processes. 
Furthermore, some officials indicated that, given current limited resources,
individual grants awarded to localities under a block grant might be too small
to do much good. 

While there is no consensus on this issue, many acknowledge that efforts to
reduce program fragmentation are appropriate, and selected programs have been
consolidated.  For example, in fiscal year 1993 two HUD programs--the
Supportive Housing Demonstration Program (SHDP) and the Supplemental Assistance
for Facilities to Assist the Homeless (SAFAH) program--were combined to form
the Supportive Housing Program (SHP).  Earlier efforts to combine selected
entitlement and demonstration programs in HUD were stopped by disagreements on
an allocation formula.\3 At that time, HUD officials said the difficulty of
obtaining consistent, uniform data on the prevalence of homelessness in various
parts of the country became an obstacle.  Although HUD officials had hoped that
figures from the 1990 Census would establish a basis for distributing these
funds, various problems and inconsistencies in the collection of the Census
data led many to argue against their use in allocating funds to assist the
homeless.\4

On April 26, 1994, HUD submitted proposed legislation to the Speaker of the
House of Representatives that would reorganize its six McKinney Act programs
into a single formula grant program.\5 Under the proposed reorganization, whose
purpose is to give localities greater flexibility in designing strategies for
assisting the homeless that best meet local needs, funds would be allocated to
state and local governments using a mechnism similar to that used in the
Emergency Shelter Grants program.  However, state and local governments would
be required to involve nonprofit assistance organizations in developing a local
plan for assisting the homeless and to make at least 51 percent of the grant
funds available to such organizations. 


--------------------
\3 The Stewart B.  McKinney Homeless Assistance Amendments Act of 1990
authorized the Secretary of HUD to issue regulations establishing an allocation
formula that would reflect each jurisdiction's share of the nation's need for
housing assistance for the homeless. 

\4 See 1990 Census:  Limitations in Methods and Procedures to Include the
Homeless (GAO/GGD-92-1, Dec.  30, 1991). 

\5 These six programs are Emergency Shelter Grants, Supportive Housing, Shelter
Plus Care, Section 8 SRO Rehabilitation, Safe Havens, and Rural Homeless
Housing Assistance. 


   CONCLUSIONS
-------------------------------------------------------------------- Chapter 3:3

Local service providers criticized the McKinney demonstration programs'
restrictions on (1) renewing grants, which limited the providers' ability to
sustain successful programs, and (2) on funding, which limited the providers'
ability to offer services to all who could benefit from them.  Federal
officials maintained, however, that the purpose of the McKinney demonstration
programs is to test approaches for meeting the needs of the homeless--not to
sustain programs or to provide services on a large scale.  Ongoing evaluations
of the programs should indicate which approaches work and which do not, but
unless the results of the evaluations are widely disseminated, the value of the
demonstration programs will be limited.  The Domestic Policy Council's new
working group should be able to consolidate and disseminate the results to
providers and other interested parties if it continues to receive adequate
staff and funds from HUD. 

Local providers who wanted to provide comprehensive services expressed concern
about the administrative burden of managing multiple McKinney projects.  Their
primary concerns were the need to develop applications for each program and to
report similar information in different forms.  These activities absorb scarce
resources that providers would rather see allocated to serving clients.  While
acknowledging that the programs' requirements could be burdensome, federal
officials noted that some consolidation has already occurred and that further
efficiencies would, in many cases, require legislative action. 


   MATTERS FOR CONGRESSIONAL
   CONSIDERATION
-------------------------------------------------------------------- Chapter 3:4

To reduce the administrative burden created by multiple application and
reporting requirements, the Congress may wish to consider amending the McKinney
Act to (1) enable federal agencies to establish more uniform application and
reporting requirements or (2) consolidate McKinney Act programs. 


   RECOMMENDATION
-------------------------------------------------------------------- Chapter 3:5

We recommend that the Executive Director of the Domestic Policy Council's new
working group on homelessless disseminate summaries of the McKinney program
evaluations to all of the parties on the Interagency Council's mailing list. 


MCKINNEY ACT PROGRAM SUPPORT IMPORTANT
TO FUTURE EFFORTS BUT WILL NOT ALONE
FULLY ADDRESS THE PROBLEM OF
HOMELESSNESS
====================================================================== Chapter 4

Local government officials, university researchers, and providers of services
to the homeless in the four cities we studied expect homelessness to remain a
serious problem.  These local experts believe that all levels of government, as
well as the nonprofit sector, must work in partnership to address the problem
of homelessness.  They plan to continue supplying emergency food and shelter
and to provide more options for improving the quality of life for homeless
people and helping them achieve independence.  In addition, they want to
increase efforts to prevent other people from becoming homeless.  These experts
want the federal government to sustain current levels of funding for McKinney
Act emergency food and shelter programs and to increase funds for prevention
efforts, longer-term housing, and the comprehensive services that the homeless
need to help them become independent. 

Local experts also said that they need tools beyond the current scope of
McKinney Act programs to effectively address the problem of homelessness. 
Above all, they cited the need for affordable housing.  They indicated that the
current safety net of mainstream social programs--designed to assist the
general population of low-income people through subsidized housing, income
support, and other means--does not have sufficient capacity to prevent new
episodes of homelessness or adequately serve people who are already homeless. 
Local experts also cited unemployment and the loss of well-paying urban jobs as
causes of homelessness in their cities.  They said that significant reductions
in homelessness will require expanding the capacity of mainstream social
programs, improving homeless people's access to these programs, and increasing
employment opportunities for low-income people.  In studies we reviewed,
national experts discuss many of the same issues raised by local experts in our
case study cities and recommend some of the same remedies to homelessness. 

Two recent federal initiatives support the development of a comprehensive
strategy to alleviate homelessness.  In February 1994, a task force established
by the Speaker of the House of Representatives recommended improvements in
existing McKinney Act programs, better services for the prevention of
homelessness, and better access for the homeless to mainstream assistance
programs.  Also, the Domestic Policy Council's working group on homelessness,
which succeeded the Interagency Council on the Homeless, is preparing a
coordinated federal plan to break the cycle of homelessness and prevent future
homelessness.  This plan, which was required by a May 1993 executive order to
the Interagency Council and its member executive agencies, is to identify
legislative and administrative proposals to streamline or consolidate existing
programs to make them more effective in serving the homeless.  Although funding
for the Interagency Council was eliminated for fiscal year 1994, the working
group continued to develop the plan and expected to make it public on May 17,
1994. 

Local and national experts and the Speaker's task force agree that any
substantially more effective strategy will cost significantly more than is now
being spent.  The extent to which the federal government can respond poses a
difficult budget decision for the Congress. 


   CITIES NEED MCKINNEY PROGRAM SUPPORT
   TO CONTINUE EFFORTS TO ASSIST THE
   HOMELESS
-------------------------------------------------------------------- Chapter 4:1

Local experts in our case study cities predict that homelessness will remain a
serious problem in their cities because affordable housing remains scarce,
economies are stagnant, and funding for income assistance programs has been
cut.  They said that they plan to expand public awareness of the problem,
refine their strategies and priorities for relieving homelessness, and work to
develop additional low-income housing. 

Local experts in three cities also stressed the need to maintain current levels
of emergency services, while officials in the fourth city were still trying to
expand emergency assistance.  Local providers believe that recent cuts in
funding for McKinney Act emergency programs are premature because the need is
still so great.\1 For example, city officials in San Antonio estimated that
shelters have been serving only about 16 to 20 percent of those in need.  In
Baltimore, about as many people were turned away from shelters as were given
beds.  Local experts told us that it is critical to strike a balance between
maintaining emergency support and expanding prevention efforts and long-term
housing opportunities.  According to one city government official, the current
number of homeless people needing emergency shelter and basic services will
continue for the foreseeable future. 

All the cities plan to provide more options to help homeless people move from
emergency shelters to more stable and longer-term housing arrangements.  Local
experts believe that interim housing, such as that provided in the McKinney
transitional housing program, is important because it offers supportive
services that clients need to become independent.  They expect the new McKinney
Shelter Plus Care and Safe Havens programs to provide longer-term housing to
two particularly challenging groups of homeless clients, the mentally ill and
those with substance abuse problems.  Local officials in three of the four
cities hope to expand their use of the McKinney permanent housing programs,
including the SRO program and a program for handicapped homeless persons. 
Additionally, some service providers believe that the McKinney Act should fund
the construction of permanent low-income housing projects. 

Local experts in all four cities told us that they hope to increase their
emphasis on preventing homelessness and would like McKinney Act programs to
provide additional resources.  According to a St.  Louis official, the city
first needs more money to help poor people pay their utility bills and rent so
that their utilities are not turned off and they are not evicted.  This type of
assistance is crucial to preventing homelessness.  The official pointed out
that once people enter the shelter system, the cost of supporting them is much
greater.  One of Baltimore's goals is to control the growth of homelessness by
increasing the number of prevention programs, such as a neighborhood
intervention program.  Local experts acknowledge that FEMA's Emergency Food and
Shelter Program (EFSP) and HUD's Emergency Shelter Grants (ESG) and
Supplemental Assistance for Facilities to Assist the Homeless (SAFAH)\2
programs have provided some assistance for prevention; however, this funding
has been limited. 

To improve the quality of life for homeless people and to increase their
chances of becoming independent, providers believe that they must offer
comprehensive services that go beyond emergency food and shelter.  They
described homeless clients' needs for such things as substance abuse treatment,
education, special programs for youth between 11 and 15 years old, and
employment and training programs--for which little or no funding has been
targeted specifically to homeless people except through McKinney Act programs. 
For example, Baltimore providers said that although many homeless clients had
alcohol and drug abuse problems, there were few places in the city to send them
for treatment.  Homeless clients we spoke to in the four cities cited various
reasons for their homelessness and told us that they needed a range of services
to help them cope with such things as drug abuse, other personal problems, and
unemployment.  As discussed in chapter 3, most of the McKinney programs in
these areas are research or demonstration programs that serve a small number of
people.  Service providers believe that McKinney programs can play a larger
role and want to see funding for them increased. 


--------------------
\1 Funding for McKinney emergency service programs was cut by $33 million from
fiscal year 1992 to fiscal year 1993 (over $90 million was proposed to be cut),
even though the overall funding for McKinney programs was increased by $125
million. 

\2 In fiscal year 1993, SAFAH became part of the Supportive Housing Program. 


   NEEDS BEYOND THE SCOPE OF THE
   MCKINNEY ACT PROGRAMS MUST BE
   ADDRESSED
-------------------------------------------------------------------- Chapter 4:2

While McKinney Act programs can play an important role in assisting the
homeless, they will not fully address the problem of homelessness.  As
discussed previously, these programs are meeting only a portion of the
identified needs of people who are already homeless and few of the needs of the
large numbers of people who are at risk of becoming homeless.  Local experts
told us that actions must be taken to expand the capacity of mainstream
programs that serve low-income people.  The greatest need, they said, was for
affordable housing.  Both local experts and homeless people also said that
homeless people's access to mainstream programs needs to be improved and that
employment opportunities need to be expanded to prevent people from becoming
homeless.  In all four cities, local experts told us that, in addition to
McKinney programs, the cities need: 

affordable housing options, for which all levels of government would share
responsibility;

additional resources for the mentally ill, especially long-term affordable
housing with residential services;

programs for treating substance abuse;

strategies for supplementing the income of low-income people;

strategies for creating jobs that pay a decent wage;

policies endorsing the right of all to basic life necessities, including
education and health care; and

modification in attitudes and the political will to make changes, such as those
suggested above, across all levels of government. 


      OFFICIALS BELIEVE MAINSTREAM
      PROGRAMS NEED TO BE LARGER AND
      MORE ACCESSIBLE TO HOMELESS
      PEOPLE
------------------------------------------------------------------ Chapter 4:2.1

Local experts in all four cities told us that the principal mainstream programs
designed to assist low-income people (e.g., rent subsidy, income assistance,
and social service programs) do not have the capacity to serve and may be
inaccessible to homeless people.  Some believe that programs for assisting the
homeless are serving as a safety net for the mainstream social programs, which
themselves were designed to be a safety net for low-income people.  While most
local experts believed in intervening and targeting assistance to the homeless
by, for example, providing services in shelters, some said that such assistance
could make clients dependent and institutionalize homelessness by establishing
a separate system to assist this group of very-low-income people.  Local
providers and federal program administrators agreed that, whenever possible,
mainstream programs should serve the homeless.  However, to do so, they must
have the capacity to serve and must be accessible to homeless people. 

Local experts in all four of our case study cities cited evidence of
insufficient capacity in mainstream programs, most commonly noting long waiting
lists for assisted housing (Section 8 rent subsidies and public housing),
reductions in state income assistance, and insufficient physical and mental
health care services.  Some of their examples follow: 


         CAPACITY OF HOUSING ASSISTANCE
         PROGRAMS IS INSUFFICIENT
---------------------------------------------------------------- Chapter 4:2.1.1

There are two main forms of federal housing assistance-- public housing and
housing that is privately owned but subsidized by the government.  Both types
of housing assistance are provided through programs administered by HUD.  Other
low-income households may receive assistance through similar programs funded by
state or local governments. 

City officials in Baltimore said that the wait for assisted housing is 8 to 10
years.  There are 31,000 people on the waiting list, including more than 15,000
with federal preference, a category that includes homeless people. 

The number of public housing units in San Antonio has increased little over the
past 10 years.  Currently, 20,000 people are waiting for Section 8 subsidies. 
The waiting list has been closed since 1985. 

In May 1992, 3,269 people were on Seattle's waiting list for public housing,
including over 600 homeless people.  Additionally, over 6,000 people were on
waiting lists for Section 8 certificates. 

During the 1980s, St.  Louis lost almost 7,200 housing units, and the number of
vacant and boarded up units increased.  The number of habitable public housing
units has also declined over the past 10 years.  There is a 6-year wait for
public housing. 


         CAPACITY OF INCOME ASSISTANCE
         PROGRAMS IS INSUFFICIENT
---------------------------------------------------------------- Chapter 4:2.1.2

Several federal and state programs provide monthly cash benefits to low-income
people.  These programs include the federal Aid to Families with Dependent
Children (AFDC) program; Supplemental Security Income (SSI), a federal
entitlement program that supplements the income of poor aged, blind, or
disabled people; and General Assistance programs--General Relief, Public
Assistance, or Home Relief programs--that are funded and administered by
states, counties, or cities to aid poor, single, able-bodied individuals. 

According to local experts, budget cuts are making it more difficult to get
income assistance in Baltimore.  For example, the state has reduced income
maintenance levels, cash payments, and medical assistance.  In addition, the
General Assistance program has been changed to a loan program.  Applicants must
now apply to the state for a loan and sign a promissory note to repay the
funds.  Also, like many other states, Maryland does not augment federal SSI
benefits. 

Income assistance levels in Texas are among the lowest in the country.  For
example, in 1990 the state's maximum AFDC benefit was the third lowest in the
nation.  Texas' AFDC benefit levels have not changed since 1985.  The state has
no General Assistance program.  Like Maryland, Texas does not provide
additional funds to supplement federal SSI benefits. 

The state of Missouri has one of the lowest AFDC benefit rates in the country. 
The maximum AFDC benefit in Missouri for a family of three with no other income
has decreased by about 20 percent since 1970.  While the maximum AFDC benefit
for such a family in the St.  Louis area was $292 per month in 1992, the fair
market rent was $498 per month.\3

Over the last decade, AFDC payments in Seattle have increased by 9 percent, but
rental housing prices have increased by more than 83 percent.  The city
estimates that at least 32,000 low-income renters pay more than 30 percent of
their income for housing.  Many of these households are at risk of becoming
homeless through loss of income, rising rents, federal housing cutbacks, and
the continued loss of affordable housing to demolition and conversion. 


--------------------
\3 HUD establishes fair market rents for each metropolitan and nonmetropolitan
area in a state.  Fair market rents reflect rents at the 45th percentile in the
area for a given number of bedrooms. 


         CAPACITY OF OTHER SOCIAL
         SERVICE PROGRAMS IS
         INSUFFICIENT
---------------------------------------------------------------- Chapter 4:2.1.3

Other social services for low-income people are provided through programs
funded by HHS, such as Medicaid and Social Security Disability Insurance
(SSDI), as well as through locally funded programs that provide treatment and
services to people who are mentally ill or have substance abuse problems. 

Service providers in Baltimore told us that it is becoming more difficult to
get medical benefits for homeless people through mainstream programs.  They
noted that federal Medicaid assistance has been reduced over the past 3 years. 
Outpatient visits to clinics and inpatient hospital services have been
eliminated, and substance abuse services have been reduced.  For example, in
1975 Medicaid covered 12 days of detoxification treatment, but since 1991 it
has covered only 3 days. 

Local experts in Seattle reported that they have not been able to place
homeless mentally ill people that they have identified through McKinney-funded
outreach efforts into the long-term mental health care system because the
system has reached capacity. 

According to local experts in St.  Louis, a $181 million shortfall in state
revenues in 1992 led to cuts in social services, particularly in mental health
and substance abuse services.  Two hundred facilities have been closed in
Missouri because of cutbacks, including inpatient facilities.  People receiving
outpatient treatment in lieu of inpatient care are expected to stay in a
shelter for the homeless during treatment.  Shelters must then provide
additional beds and services for these people, including counseling to ensure
that they continue outpatient treatment. 

Local experts in San Antonio told us that publicly funded services for the
mentally ill are limited.  Although state general funds help support mental
health programs, the need is greater than the available funds.  They also told
us that substance abuse services are virtually nonexistent.  Currently, one
public facility in the city provides 20 beds for detoxification treatment. 


         HOMELESS PEOPLE HAVE
         DIFFICULTY ACCESSING
         MAINSTREAM PROGRAMS
---------------------------------------------------------------- Chapter 4:2.1.4

Providers told us that it is difficult for some homeless people to obtain
services through mainstream social programs.  Homeless people we interviewed
also said that it was difficult to access some mainstream programs.  Agencies
administering these programs sometimes are unable or reluctant to take into
account the special circumstances of homeless people, such as their not having
identification documents and not meeting program residency requirements. 

Some providers believe it may also be difficult for homeless people to compete
with others for assistance because they require more intense efforts than other
eligible people.  For example, one provider said that mainstream employment and
training programs may not be able to provide as much help as is needed to make
homeless clients employable.  Another provider said that a health program may
be reluctant to assist some homeless people because its funding is based on the
number of clients who make regular appointments.  Providers attributed the
inability or reluctance of some mainstream program administrators to serve
homeless people to the administrators' enormous case loads and the large number
of needy people requiring assistance through these programs. 

Another problem with mainstream programs is that human services are organized
by category, while the problems of homeless people cross traditional
categories.  For example, a mainstream employment program would not help a
homeless person obtain housing or supportive services. 


      UNEMPLOYMENT AND THE LOSS OF
      WELL-PAYING URBAN JOBS CONTRIBUTE
      TO HOMELESSNESS
------------------------------------------------------------------ Chapter 4:2.2

Local experts in three of the four case study cities (St.  Louis, San Antonio,
and Baltimore) told us that unemployment has contributed to their growing
homeless populations.  Additionally, local experts in all four cities cited a
decline in the number of higher-paying manufacturing jobs and the difficulty
that employees in lower-paying service jobs were experiencing in meeting basic
living costs. 

St.  Louis has lost jobs while employment has grown in the suburbs and the
fringes of the metropolitan area, leaving the city with a generally poorer
population and fewer job opportunities.  Local experts told us that the number
of homeless families has increased because people who lack marketable skills
are being laid off and cannot find new jobs. 

Likewise, San Antonio cited a loss of higher-paying construction, mining, and
manufacturing jobs.  A city with five military installations, San Antonio
expects an increase in layoffs and hiring freezes as military cuts and the
federal budget deficit increase the likelihood of base closings.  Local
officials in San Antonio said that although many homeless people are willing to
take even day labor (temporary manual labor that lasts fewer than 3 days and
pays in cash), few positions are available, the work is unregulated, and the
pay is low.  Also, such work is intermittent and does not provide a reliable
income to sustain a person or family.  The city estimates that over
three-fourths of its homeless people have only limited skills and experience,
increasing their difficulty in obtaining suitable employment.  Officials say
additional, appropriate employment training and placement services are required
if the majority of homeless people are to live productively, independent of
continued public support. 

Baltimore suffers from high unemployment and is losing higher- paying blue
collar jobs while gaining lower-paying service jobs.  Local experts in
Baltimore said that an increase in the minimum wage or additional financial
assistance through other support mechanisms would be needed for a worker
employed full time at minimum wage to afford housing in standard condition in
Baltimore.  For example, a person working full time for minimum wages would
have to pay about 48 percent of his/her income to obtain a one-bedroom
apartment, and about 53 percent for a two-bedroom apartment.  Such a situation
leaves few resources to meet other needs. 

While employment trends in Seattle suggest continuing job growth in the 1990s,
most of the growth is expected in lower-paying occupations:  40,000 new retail
trade and service sector jobs are anticipated.  However, in late January 1993,
Seattle's largest industrial manufacturing firm (the state's largest private
employer) announced that it would cut its commercial jet production by 35
percent.  This reduction is expected to eliminate about 19,000 well-paying jobs
in the Puget Sound area by mid-1994. 


      NATIONAL STUDIES SUPPORT LOCAL
      EXPERTS' OPINIONS
------------------------------------------------------------------ Chapter 4:2.3

Studies published by national experts support the views of the local experts we
interviewed and also indicate that homelessness continues to be a serious
problem for this country.  These national experts agree that policymakers'
goals for the future should be to treat the underlying causes of homelessness
by focusing on long-range preventive solutions.  All further concur that,
because the homeless population is diverse and homeless individuals often have
different needs, success will require substantive measures that simultaneously
address the various causes of homelessness.  These national experts agree that
approaches and resources will need to be focused on a range of remedies, such
as more affordable housing, income assistance, employment and training
opportunities, and social services for groups with acute problems (including
mental illness).  The studies differ, however, in the emphasis they place on
different efforts. 

A number of studies we reviewed discuss the lack of affordable housing and cite
shortfalls in the stock of low-income and subsidized housing.  According to one
study, more than a million households were listed nationwide on waiting lists
for public housing at the end of 1988, and approximately 800,000 households
were listed on waiting lists for publicly subsidized but privately owned rental
housing.\4 Several studies call for the construction of more low-cost housing,
particularly of SRO dwellings in some urban areas. 

Some national experts predict that the poor will become increasingly vulnerable
to homelessness because public income assistance is inadequate, employment
opportunities are limited, and many jobs are low paying.  These experts
conclude that the groups most at risk of becoming homeless (i.e., minorities,
men with low skills, and families headed by women) will have increasing
difficulty rising above poverty because growth in jobs is slow and the labor
market is shifting from higher-paying manufacturing jobs to lower-paying
service jobs.  While several experts agree that creating jobs and reducing
poverty will improve the general welfare, one expert makes a direct link
between persistent homelessness and a shift in the United States from a
manufacturing to a service economy and suggests that growth in productivity
will help prevent homelessness.\5 Studies proposing solutions call for
increasing employment opportunities, raising wages, and offering the education
and job training programs that give unskilled poor people the skills they need
to compete for better, higher-paying jobs in the future. 

Research also emphasizes the need to address some of the personal causes of
homelessness, especially mental illness and substance abuse.  Several studies
point out that a substantial commitment of resources must be made to help the
large number of homeless people with these problems. 

Some researchers believe that mainstream social service programs have failed
those with serious mental health problems.  They contend that the community
mental health system is more concerned about "worried well" people with less
severe problems.  Others indicate that administratively complex eligibility
requirements and applications for programs in the social service system
needlessly deprive homeless people of access to benefits.  Furthermore, some
studies suggest that the current system is ill equipped to handle some homeless
people's ongoing needs for intensive and integrated services. 

Suggested solutions to personal problems that lead to homelessness include
long-term supportive housing for the disabled and treatment and aftercare
facilities for people with substance abuse problems.  Other services--such as
vocational training and training in managing money and in social skills--need
to be provided to help people leave homelessness and reduce their chances of
becoming homeless again.  Several studies point out that the responsibility for
providing this assistance rests over a wide spectrum.  In addition to the
federal government, local governments, community organizations, private
businesses, and individuals (including the homeless) need to join in fighting
homelessness. 


--------------------
\4 Paul A.  Leonard, Cushing N.  Dolbeare, Edward B.  Lazere, and Barry Zigas,
A Place to Call Home:  The Low Income Housing Crisis Continues (Washington,
D.C.:  Center on Budget and Policy Priorities and Low Income Housing
Information Service, Dec.  1991). 

\5 Martha R.  Burt, Over the Edge:  The Growth of Homelessness in the 1980s
(New York:  Russell Sage Foundation, 1992). 


      RECENT FEDERAL EFFORTS
      ACKNOWLEDGE THE NEED TO MODIFY
      MAINSTREAM PROGRAMS
------------------------------------------------------------------ Chapter 4:2.4

Some administrators of federal mainstream programs acknowledged that their
programs are not serving all those in need of assistance.  For example, an HHS
five-city study of homeless families with children found that mainstream
programs were "threadbare" in some cities and that it was counterproductive to
send homeless people into a system that was already overloaded.  Deficiencies
cited included inadequate income support and a shortage of subsidized housing;
enough subsidized child care to meet only one-third of the demand; waiting
lists of several years for Head Start; limited availability of developmental
services; barriers in mainstream health service systems to obtaining prenatal
care; and demand greatly exceeding supply for inpatient services for substance
abuse treatment.\6

Federal officials pointed out that some agencies have begun to take
actions--but acknowledged that additional efforts are needed--to remove
barriers that prevent homeless people from accessing mainstream programs, to
improve linkages between mainstream programs and programs for the homeless, and
to provide more integrated services that address the full range of clients'
needs.  While we identified a few encouraging federal efforts to address these
needs, the efforts had not been implemented across all mainstream programs. 

We found that HHS is conducting more outreach to help eligible homeless clients
apply for entitlement programs such as AFDC, Medicaid, and SSI.  As mentioned
in chapter 3, the Departments of HUD, HHS, VA, Labor, and Education are now
evaluating a total of 11 McKinney programs.  These evaluations should provide
useful information for improving the way in which the agencies' mainstream
programs serve homeless people.  For example, a new McKinney demonstration
program administered by HHS, Access to Community Care and Effective Services
and Supports (ACCESS), is seeking to identify promising approaches for
integrating services and removing impediments to severely mentally ill homeless
people's receipt of housing, treatment, and other supportive services. 
However, none of the agencies has thus far planned for systematically
incorporating into its mainstream programs lessons learned from its McKinney
demonstration programs and evaluations. 

Not only have departments tried to improve individual programs but the federal
government has also taken some broader actions.  In February 1993, the Speaker
of the House of Representatives established a task force to look at long-term
solutions to the problem of homelessness.  The objectives of the Speaker's task
force were consistent with the previously discussed issues raised by local and
national experts.  Specifically, these objectives included improving
communication and coordination among and within the federal executive and
legislative entities responsible for programs to assist the homeless and to
prevent homelessness; ensuring to the extent feasible that federal policies
take into account the root causes of homelessness; and determining which
federal programs work for both homeless and mainstream populations.  The task
force's report, published in February 1994, supports the changes identified by
the experts and recommends (1) improving access to affordable housing; (2)
ensuring economic security, including creating jobs that pay an adequate
minimum wage and reforming income support programs, such as SSI and AFDC; and
(3) providing necessary services to prevent homelessness.  The task force's
report also acknowledges that McKinney programs alone cannot solve
homelessness.  The report recognizes that, in operating their mainstream
programs, federal, state, and local departments of housing, human services,
labor, and education need to assume more responsibility for the homeless even
as the Congress funds McKinney Act programs or other programs for the homeless. 

In May 1993, an executive order directed the Interagency Council and its
federal member agencies to establish a single coordinated federal plan for
breaking the cycle of existing homelessness and for preventing homelessness in
the future.  The order directed the Interagency Council to recommend ways to
encourage and support creative local approaches to breaking the cycle of
homelessness, including linking current assistance for the homeless to
permanent housing assistance and employment opportunities.  Although the
Interagency Council did not receive funding for fiscal year 1994, its
successor, the Domestic Policy Council's working group on homelessness,
supported by HUD, continued to develop the plan.  According to HUD's Deputy
Assistant Secretary/or Economic Development, the plan was scheduled to be made
public on May 17, 1994. 


--------------------
\6 "Homeless Families with Children:  Programmatic Responses of Five
Communities," Office of the Assistant Secretary for Planning and Evaluation,
HHS, May 1991. 


   CONCLUSIONS
-------------------------------------------------------------------- Chapter 4:3

Predicting that homelessness will remain a serious problem in their localities,
the experts we consulted in four cities want to see federal funding maintained
at current levels for emergency services and increased for programs that
provide longer-term housing options, prevent homelessness, and offer
comprehensive social services.  However, these local experts and many federal
officials agree that McKinney Act programs are too limited in scope to solve
homelessness.  With national experts on homelessness, they believe that
long-term efforts are needed to address the causes of homelessness--a shortage
of affordable housing, unemployment, and an inadequate system of care for the
mentally ill and those who abuse drugs--and that mainstream assistance programs
should be expanded and made more accessible to the homeless.  We believe that
agencies' ongoing evaluations of McKinney demonstration programs should suggest
strategies for delivering services to the homeless that can be integrated with
mainstream assistance programs to improve these programs' ability to serve the
homeless. 

Although McKinney programs have provided federal resources that enabled
communities to deliver additional food, shelter, and social services to the
homeless, they have not eliminated homelessness.  To substantially reduce the
problem, we believe a broader strategy is needed.  Two federal initiatives
could support the development of a broader strategy.  The Speaker's task force
on homelessness provided recommendations in February 1994.  The Domestic Policy
Council's working group was scheduled to make its recommendations public on May
17, 1994.  Both the report of the Speaker's task force and the observations of
the experts we consulted suggest that additional resources will be needed to
make headway in the fight against homelessness.  Ultimately, the Congress will
have to decide whether to increase federal spending and where to allocate
federal dollars for this effort. 


   RECOMMENDATION
-------------------------------------------------------------------- Chapter 4:4

We recommend that the Secretaries of the Departments of HUD, HHS, VA, Labor,
and Education, after completing the evaluations of their respective McKinney
Act demonstration and research programs, incorporate successful strategies for
working with homeless people into their mainstream programs. 


KEY EVENTS IN THE PROVISION OF SERVICES
FOR THE HOMELESS IN THE FOUR CASE STUDY
CITIES
===================================================================== Appendix I

                Food and
Time period     shelter         Health          Employment      Education
--------------  --------------  --------------  --------------  ----------------
Before 1980     All cities had  The movement    Local           Basic adult
                emergency food  to              employment      education
                and shelter     deinstitutiona  offices in all  programs existed
                programs        lize the        four cities     in all four
                provided by     mentally ill    provided on-    cities. The
                churches,       was under way   the-job         programs did not
                missions, the   nationally.     training        target the
                Salvation                       programs for    homeless.
                Army, and                       low-income
                other private                   people through
                groups.                         such programs
                                                as the
                                                Comprehensive
                                                Employment
                                                Training Act.
                                                The programs
                                                did not target
                                                the homeless.

                Some shelters   Public health
                for victims of  clinics,
                domestic        hospitals, and
                violence and/   churches
                or family       provided
                shelters        health care
                existed in all  for low-
                four cities.    income people,
                                including the
                                homeless, in
                                all four
                                cities.

                Two cities      In Baltimore,
                began to        physicians and
                appropriate     volunteer
                Community       health
                Development     providers
                Block Grant     visited
                (CDBG) funds    shelters.
                to assist the
                homeless--
                Seattle (1978)
                and St. Louis
                (1979).

                In Seattle,
                local
                coalitions
                were calling
                attention to
                homelessness.
                In 1979, the
                Seattle/King
                County
                Emergency
                Housing
                Coalition
                (which became
                the Seattle/
                King County
                Coalition for
                the Homeless
                in the 1980s)
                was formed.

                In Baltimore,
                local
                coalitions
                organized a
                strong
                coalition of
                food service
                providers, and
                Project
                P.L.A.S.E.
                (People
                Lacking Ample
                Shelter and
                Employment)
                initiated a
                social service
                outreach
                program to the
                homeless at a
                local food
                kitchen.

1980s           In all four     Three cities    A small number  Basic adult
(Pre-           cities,         (Baltimore,     of employment   education
McKinney)       efforts to      San Antonio,    services were   programs of the
                provide         and Seattle)    established     1970s continued
                emergency food  provided        specifically    unchanged.
                and shelter     systematic      for the
                were expanded,  outreach to     homeless in
                and FEMA funds  the homeless    three cities
                became          for the first   (Baltimore,
                available to    time as Robert  Seattle, and
                feed and        Wood Johnson/   St. Louis).
                shelter the     Pew Memorial
                homeless.       Trust and
                                Health Care
                In St. Louis,   for the
                homeless        Homeless funds
                individuals,    became
                represented by  available.
                Legal Services
                of Eastern      In St. Louis,
                Missouri,       an anonymous
                filed a suit    donation was
                against the     used to
                city and mayor  develop a new
                to require      program for
                them to         delivering
                provide         services to
                services to     the homeless
                the homeless.   at the Health
                                Care for the
                San Antonio     Homeless
                began to        Coalition.
                appropriate
                CDBG funds for  In all four
                the homeless    cities, the
                in 1984.        homeless
                                mentally ill
                All four        were treated
                cities          with other
                provided some   low-income
                limited,        populations in
                interim         clinics or
                housing for     hospital
                the homeless    emergency
                before          rooms.
                McKinney
                funding became
                available.

                Three cities-   In St. Louis,
                -Baltimore      the Shamrock
                (1981),         Club was
                Seattle         opened at St.
                (1984), and     Patrick's
                St. Louis       Center to
                (1985)--        provide
                appointed task  various
                forces on       services
                homelessness.   specifically
                                to the
                Cities and      homeless
                states began    mentally ill.
                funding
                projects for    Researchers at
                the homeless    Johns Hopkins
                through bonds   University in
                and housing     Baltimore
                trusts.         initiated
                Seattle passed  research on
                a Housing Levy  the health
                bond issue,     needs of the
                and the state   homeless.
                of Washington
                established a
                housing trust
                fund.

                City general
                funds and
                state
                Emergency
                Shelter and
                Food
                Assistance
                funds became
                available.

                In Baltimore,
                state funds
                for services
                to the
                homeless
                became
                available.

1987-89         In all four     The McKinney    In all four     In all four
(McKinney)      cities,         Health Care     cities,         cities, McKinney
                McKinney,       for the         employment      programs
                local,          Homeless (HCH)  programs were   provided the
                private, and    program         established     majority of the
                non-McKinney    expanded        specifically    funding for
                funds were      services to     for the         educating
                used for        the homeless    homeless.       homeless adults
                transitional    in the four     These programs  and children.
                housing         cities.         were funded
                projects.                       through the     In Seattle, a
                                Private funds   McKinney Act    McKinney program
                Local funds     for health      or by private   established
                for the         services also   nonprofit       adult education
                homeless        increased. For  organizations.  specifically for
                increased. For  example, the                    the homeless.
                example, the    Comic Relief    For example,    McKinney funds
                San Antonio     Telethon was    in Seattle and  also
                Housing Trust   introduced in   St. Louis,      supplemented a
                Fund and the    all four        McKinney funds  program for the
                Seattle         cities to       supported job   homeless that
                Housing Trust   raise funds     search and      became the model
                Fund were       for health      placement       for the McKinney
                established.    care for the    services for    Homeless
                                homeless.       the homeless    Children and
                Baltimore                       and homeless    Youth Exemplary
                began                           veterans, and   Grant program.
                appropriating                   in Baltimore
                CDBG funds to                   an employment
                assist the                      program for
                homeless in                     the homeless
                1989.                           was funded
                                                through a
                San Antonio                     church
                established a                   organization.
                task force on
                the homeless
                in 1989.

                                                                St. Louis
                                                                provided funding
                                                                for a skills
                                                                center to be
                                                                operated by a
                                                                nonprofit
                                                                organization and
                                                                for educational
                                                                programs for the
                                                                homeless and
                                                                those at risk of
                                                                becoming
                                                                homeless.

1990s           San Antonio     St. Louis used  Employment      In three cities,
                used McKinney   state general   programs        additional
                transitional    funds to treat  remained        McKinney and
                housing         the mentally    relatively      other federal
                program funds   ill.            unchanged from  funds were
                to develop a                    the 1980s.      awarded.
                multiservice    Seattle-King
                center for      County          In Baltimore,   For example,
                homeless        reorganized to  the Downtown    Seattle received
                adults and      better          Partnership     two grants for
                families. In    coordinate      (of local       homeless
                Baltimore,      programs for    businesses)     children and
                single room     the mentally    provided        youth, Baltimore
                occupancy       ill. This       employment      received two
                hotels (SROs)   coordinated     programs for    awards for
                were developed  effort is       the homeless.   homeless
                for men and     known as the                    children and
                women.          Downtown        In San          adults, and the
                                Access,         Antonio,        St. Louis
                St. Louis       Engagement and  however,        Department of
                opened the      Transition      McKinney funds  Education funded
                Housing         Network         were lost,      an existing
                Resource        (DAETN).        resulting in    program.
                Center,                         the loss of
                operated by a                   outreach and
                nonprofit                       employment
                organization                    assistance to
                under contract                  homeless
                to the city.                    veterans.
                This center
                centralizes
                the intake and
                assessment of
                homeless
                people seeking
                assistance.

1990s (cont.)   The Seattle     Baltimore                       McKinney funding
                Housing Levy    Mental Health                   enabled
                funded a        Systems                         education
                permanent       received state                  programs for
                housing         funds to                        children to
                project for     develop an                      expand, in
                mentally ill    after-care                      Baltimore, an
                adults and a    pilot program                   after-school
                transitional    in the area of                  program opened
                housing         case                            in nine
                project for     management,                     shelters.
                single men in   opened a
                recovery.       convalescent
                                care shelter
                The state of    and
                Texas           therapeutic
                established a   nursery,
                housing trust   implemented a
                fund. The San   representative
                Antonio         payee program
                Housing Trust   for the
                funded three    homeless
                transitional    chronically
                housing         mentally ill,
                projects.       and was
                                awarded a
                A "Tent City"   McKinney
                was erected in  research
                Seattle in      demonstration
                1990 by         grant for
                homeless        assertive
                people          community
                demonstrating   treatment.
                for additional
                shelters.

                Seattle
                officials have
                been planning
                to use some
                facilities
                (e.g.,
                existing
                barracks) to
                house the
                homeless on
                San Point
                Naval Base,
                which is
                scheduled for
                closure.

                In Baltimore,
                two vacant
                city-owned
                fire stations
                were converted
                to rent-free
                shelters.
--------------------------------------------------------------------------------

EVALUATION RESULTS FROM MCKINNEY ACT
COMPETITIVE PROGRAMS
==================================================================== Appendix II

Program             Program objective             Evaluation status/results
------------------  ----------------------------  ------------------------------
Community Mental    Develop and evaluate          Ongoing; an interim report of
Health Services     comprehensive, community-     the evaluation's findings is
Demonstration       based mental health service   due in spring 1994. The
Projects for        systems for the mentally ill  evaluation will test the
Homeless            homeless.                     relative effectiveness of a
Individuals Who                                   particular model for linking
Are Chronically                                   housing and services in order
Mentally Ill                                      to increase residential
(CMHS)                                            stability and improve the
                                                  quality of life for the target
                                                  population. A cross-site data
                                                  set will be used to permit the
                                                  direct comparison of
                                                  individual projects.

Adult Education     Enable state education        Ongoing; a national review of
for the Homeless    agencies to develop a plan    fiscal year 1991-92 is due in
(AEH)               and implement literacy        spring 1994. National reviews
                    training.                     of AEH's first 3 years (1988-
                                                  90) identified several key
                                                  elements contributing to the
                                                  success of the programs. These
                                                  included a stable living
                                                  environment for a minimum of
                                                  45 days, instruction plans
                                                  related to practical tasks and
                                                  everyday experiences, case
                                                  management and counseling,
                                                  instruction on self-esteem and
                                                  life skills, program locations
                                                  accessible to the homeless,
                                                  and funding from non-McKinney
                                                  sources. The reports also
                                                  included recommendations to
                                                  develop and test effective
                                                  alternative curricula for
                                                  homeless populations, provide
                                                  ongoing staff training, and
                                                  incorporate a program
                                                  evaluation component to aid in
                                                  program planning and
                                                  implementation. AEH served
                                                  over 71,000.

Health Care for     Deliver primary health care,  Ongoing; the evaluation is due
the Homeless (HCH)  substance abuse, treatment,   in December 1994. The
                    and mental health services    evaluation data will be used
                    in accessible locations.      to develop recommendations on
                                                  effective delivery models,
                                                  guide the design of new
                                                  programs, develop policies and
                                                  procedures on program
                                                  implementation, and develop
                                                  strategies to improve
                                                  coordination.

Health Care for     Provide medical and           Ongoing; no date has been set
Homeless Veterans   psychiatric assessments and   for the release of the sixth
(HCHV)              place clients into            annual evaluation. Previous
                    community-based treatment     national evaluations (1987-
                    facilities if necessary.      91) showed that HCHV provided
                                                  effective outreach,
                                                  assessment, treatment, and
                                                  referral services to homeless
                                                  veterans. The factor most
                                                  strongly associated with
                                                  sustained involvement in the
                                                  program and clinical
                                                  improvement was participation
                                                  in residential treatment,
                                                  especially for those who
                                                  stayed more than 30 days.
                                                  About 40,000 have been
                                                  contacted and over 7,600 have
                                                  been afforded residential
                                                  treatment.

Homeless Veterans   Support flexible and          Ongoing; 1989 and 1990 updates
Reintegration       innovative approaches to      of the evaluation are due in
Projects (HVRP)     provide job training to help  spring 1994. Findings from the
                    unemployed homeless veterans  first year of operation (1988)
                    reenter the labor force.      demonstrate that HVRP projects
                                                  developed replicable, cost-
                                                  effective approaches to
                                                  assisting homeless veterans in
                                                  overcoming barriers to
                                                  employment and retaining
                                                  productive jobs in the
                                                  community. Efforts to
                                                  successfully replicate HVRP
                                                  suggest the value of
                                                  predefining the
                                                  characteristics of the target
                                                  population to set service
                                                  delivery priorities,
                                                  developing written procedures
                                                  for tracking and following up
                                                  clients and training staff in
                                                  implementation, conducting
                                                  active and varied outreach
                                                  methods and providing ongoing
                                                  training and supervision to
                                                  staff, establishing linkages
                                                  in the local community with
                                                  other providers that serve the
                                                  same population, and
                                                  leveraging resources. The
                                                  program served 5,553 in the
                                                  first year.

Job Training for    Demonstrate innovative and    Ongoing; the final evaluation
the Homeless (JTH)  replicable approaches to      is due in 1995. Preliminary
                    providing job training and    evaluations concluded that it
                    collect information on the    is feasible to establish
                    most effective ways to        effective employment and
                    provide employment and        training programs to serve
                    training services to the      both the general homeless
                    homeless.                     population and specific
                                                  subgroups of the homeless
                                                  population at the local level.
                                                  Projects demonstrated that it
                                                  takes more than employment and
                                                  training services to help
                                                  homeless people find and keep
                                                  jobs. Comprehensive and
                                                  ongoing assessment of
                                                  participants is critical to
                                                  identifying specific obstacles
                                                  to employment, and a case
                                                  management approach is vital
                                                  in tailoring services to the
                                                  specific needs of the homeless
                                                  participants. This program
                                                  served 28,000 from 1988 to
                                                  1992.

Supportive Housing  Develop innovative            Ongoing; the evaluation is due
Program (SHP)       approaches to help the        in summer 1994. The objective
                    homeless make the transition  of the evaluation is to
                    to independent living and     develop a complete
                    provide community-based       understanding of the character
                    housing and supportive        and impacts of SHP, including
                    services for the handicapped  the cost-effectiveness of the
                    homeless.                     various demonstration
                                                  projects. The evaluation will
                                                  identify what works and why,
                                                  as well as programs and
                                                  projects that need attention.
                                                  The evaluation will cover all
                                                  awards from 1987 to 1990.

Research            Implement, document, and      Ongoing; the evaluation of
Demonstration       evaluate successful and       fiscal year 1990 grantees is
Projects for        replicable approaches to      due in fall 1994. The
Alcohol and Drug    community-based treatment     evaluation of the fiscal year
Abuse Treatment of  and rehabilitation services   1988 grantees confirmed the
Homeless Persons    for homeless individuals who  feasibility of implementing
(ADAT)              abuse alcohol and other       comprehensive programs for
                    drugs.                        treating alcohol and other
                                                  drug problems. Implementing
                                                  the programs showed that the
                                                  shelter, sustenance, and
                                                  security needs of the clients
                                                  should be met first, and the
                                                  treatment needs addressed
                                                  second; structure and
                                                  flexibility should be combined
                                                  in residential programs; the
                                                  availability of transportation
                                                  services is essential to link
                                                  residences with treatment
                                                  centers; and extensive time
                                                  for program planning, model
                                                  development, and start-up is
                                                  required.

Shelter Plus Care   Link supportive services to   Ongoing; the evaluation is due
(S+C)               rental assistance for         in July 1995. The evaluation
                    homeless persons with         will analyze SPC applications
                    disabilities--primarily       and establish a baseline
                    those who are seriously       impact data collection system
                    mentally ill, have chronic    and assess program
                    drug and/or alcohol           implementation and preliminary
                    problems, or have acquired    impacts.
                    immunodeficiency syndrome
                    (AIDS).

Supplemental        Provide comprehensive         Ongoing; the evaluation is due
Assistance for      assistance for particularly   in summer 1994. The evaluation
Facilities to       innovative programs meeting   will gather information on
Assist the          the immediate and long-term   grantees and their programs,
Homeless (SAFAH)    needs of homeless             implementation status,
                    individuals and families,     comprehensive or innovative
                    and provide additional        characteristics of programs,
                    assistance to ESG-and SHP-    client progress toward self-
                    funded projects.              sufficiency, and
                                                  recommendations for improving
                                                  programs.

Domiciliary Care    Use VA medical facilities to  Ongoing; the evaluation for
for Homeless        provide primary health care,  fiscal years 1992-93 is due in
Veterans (DCHV)     mental health, and social     summer 1994. Previous annual
                    services to homeless          national evaluations of DCHV
                    veterans or those at risk.    (1988-91) described the status
                                                  and needs of homeless veterans
                                                  and identified ways to define
                                                  or change the clinical
                                                  program. A high staff-to-
                                                  patient ratio remains the
                                                  strongest determinant of
                                                  active treatment in the
                                                  program. The data show that
                                                  the program continues to offer
                                                  treatment to an increasing
                                                  number of homeless veterans
                                                  with each passing year. Since
                                                  the program's inception, over
                                                  12,000 have been admitted to
                                                  the program.
--------------------------------------------------------------------------------

MAJOR CONTRIBUTORS TO THIS REPORT
=================================================================== Appendix III


   RESOURCES, COMMUNITY, AND ECONOMIC
   DEVELOPMENT DIVISION WASHINGTON,
   D.C. 
----------------------------------------------------------------- Appendix III:1

Marnie Shaul, Assistant Director
Woodliff Jenkins, Assignment Manager
Vondalee Hunt, Site Senior
Carolyn Boyce, Senior Social Science Analyst


   LOS ANGELES REGIONAL OFFICE
----------------------------------------------------------------- Appendix III:2

James D.  Moses, Regional Management Representative
Bonnie D.  Hall, Evaluator-in-Charge
Janet Fong, Site Senior
Lisa G.  Shibata, Evaluator


   KANSAS CITY REGIONAL OFFICE
----------------------------------------------------------------- Appendix III:3

Claudia Saul, Site Senior


RELATED GAO PRODUCTS
====================================================================== Chapter 1

Homelessness:  Demand for Services to Homeless Veterans Exceeds VA Program
Capacity (GAO/HEHS-94-98, Feb.  23, 1994). 

Homelessness:  Appropriate Controls Implemented for 1990 McKinney Amendments'
PATH Program (GAO/HEHS-94-82, Feb.  22, 1994). 

Homelessness:  Barriers Inhibit Use of Federally Held Foreclosed Property for
Homeless (GAO/RCED-93-182, Sept.  30, 1993). 

Homelessness:  McKinney Act Programs and Funding Through Fiscal Year 1991
(GAO/RCED-93-39, Dec.  21, 1992). 

Homelessness:  Single Room Occupancy Program Achieves Goals, but HUD Can
Increase Impact (GAO/RCED-92-215, Aug.  27, 1992). 

1990 Census:  Limitations in Methods and Procedures to Include the Homeless
(GAO/GGD-92-1, Dec.  30, 1991). 

Homelessness:  Transitional Housing Shows Initial Success but Long-term Effects
Unknown (GAO/RCED-91-200, Sept.  9, 1991). 

Homelessness:  Federal Personal Property Donations Provide Limited Benefit to
the Homeless (GAO/RCED-91-108, July 15, 1991). 

Homelessness:  Access to McKinney Act Programs Improved but Better Oversight
Needed (GAO/RCED-91-29, Dec.  27, 1990). 

Homelessness:  Action Needed to Make Federal Surplus Property Program More
Effective (GAO/RCED-91-33, Oct.  9, 1990). 

Homelessness:  Too Early to Tell What Kinds of Prevention Assistance Work Best
(GAO/RCED-90-89, Apr.  24, 1990). 

Homelessness:  Homeless and Runaway Youth Receiving Services at Federally
Funded Shelters (GAO/HRD-90-45, Dec.  19, 1989).