Chronic Homelessness

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  • Chronic Homelessness

    1. 1. From Pathology to Population Measuring and Managing Homelessness Craig Willse Program in Sociology The Graduate Center City University of New York cwillse@gc.cuny.edu
    2. 2. discourse governance technology
    3. 3. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    4. 4. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    5. 5. Historical Development of Mass Homelessness
    6. 6. Historical Development of Mass Homelessness • Post-war: Emergence of Skid Row districts
    7. 7. Historical Development of Mass Homelessness • Post-war: Emergence of Skid Row districts • 1960s to present: “Urban renewal” and the destruction of Skid Row housing
    8. 8. Historical Development of Mass Homelessness • Post-war: Emergence of Skid Row districts • 1960s to present: “Urban renewal” and the destruction of Skid Row housing • Neoliberal economic restructuring • Shift of industrial production out of U.S. • Development of domestic knowledge and service industries • Rollback of public assistance programs
    9. 9. Historical Development of Mass Homelessness • Post-war: Emergence of Skid Row districts • 1960s to present: “Urban renewal” and the destruction of Skid Row housing • Neoliberal economic restructuring • Shift of industrial production out of U.S. • Development of domestic knowledge and service industries • Rollback of public assistance programs • Late 1970s: Mass homelessness emerges as a “surplus population”
    10. 10. Historical Development of Mass Homelessness • Post-war: Emergence of Skid Row districts • 1960s to present: “Urban renewal” and the destruction of Skid Row housing • Neoliberal economic restructuring • Shift of industrial production out of U.S. • Development of domestic knowledge and service industries • Rollback of public assistance programs • Late 1970s: Mass homelessness emerges as a “surplus population” • 1987: McKinney-Vento Homeless Assistance Act
    11. 11. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    12. 12. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    13. 13. “chronic homelessness” “chronically homeless”
    14. 14. Dennis Culhane Randall Kuhn • “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” • “Patterns and Determinants of Public Shelter Utilization Among Homeless Adults in New York City and Philadelphia”
    15. 15. The ‘chronically homeless’ population could be characterized as those persons most like the stereotypical profile of the Skid Row homeless. These are people who are likely to be entrenched in the shelter system, and for whom shelters are more like long-term housing than an emergency arrangement. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)
    16. 16. In general, being older, of black race, having a substance abuse or mental health problem, or having a physical disability, significantly reduces the likelihood of exiting shelter. Dennis Culhane and Randall Kuhn,“Patterns and Determinants of Public Shelter Utilization Among Homeless Adults in New York City and Philadelphia” (1998)
    17. 17. The term ‘chronic homeless’ treats homelessness with the same language, and in the same fashion, as a medical condition or disease, rather than an experience caused fundamentally by poverty and lack of affordable housing. National Coalition for the Homeless (2002)
    18. 18. Voice of America News Broadcast July 30, 2008
    19. 19. Voice of America News Broadcast July 30, 2008
    20. 20. the “medicalization” of social problems
    21. 21. case management technologies
    22. 22. “ The logic of social services is that we’re being paid to make life better for these people. Therefore, our judgement is paramount, and [clients] ought to be following that. And when you complicate it further with our conventional view of addiction, where it’s all about, you know, shaming someone until they come around and start making better decisions for themselves . . . the whole thing just becomes a big mess. ”
    23. 23. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)
    24. 24. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)
    25. 25. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)
    26. 26. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)
    27. 27. Randall Kuhn and Dennis Culhane, “Applying Cluster Analysis to Test a Typology of Homelessness by Pattern of Shelter Utilization: Results from the Analysis of Administrative Data” (1998)
    28. 28. Michel Foucault
    29. 29. Michel Foucault Disciplinary medicine case management individual attitudes and behavior
    30. 30. Michel Foucault Disciplinary Biopolitical medicine public health case management statistics individual population attitudes and behavior patterns and costs
    31. 31. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    32. 32. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    33. 33. Malcolm Gladwell, “Million Dollar Murray” The New Yorker, February 13, 2006
    34. 34. Malcolm Gladwell, “Million Dollar Murray” The New Yorker, February 13, 2006 • 119 chronically homeless in Boston for 5 years • 18,834 emergency room visits • Minimum cost: $1,000 / visit
    35. 35. Malcolm Gladwell, “Million Dollar Murray” The New Yorker, February 13, 2006 • 119 chronically homeless in Boston for 5 years • 18,834 emergency room visits • Minimum cost: $1,000 / visit • 15 “chronically homeless inebriates” in San Diego for 18 months • 417 emergency room visits • Total average bill: $100,000 / person
    36. 36. • Death rates twice as high • 11x more likely to contract tuberculosis • Rates of HIV twice as high • 16x more likely to contract HIV • 75 new HIV cases / 100,000 adults in NYC • 1,241 new HIV cases / 100,00 adults in shelter system
    37. 37. the “economization” of health
    38. 38. From a conservative’s perspective, it saves taxpayers money. Research has “ even shown it’s cheaper in the long run to fund [housing] programs because it reduces recidivism rates. And it’s really expensive to go from shelter to street to psych hospital to jail to community courts, through all these revolving doors. So that’s what I use sometimes when I’m talking to a government type. I’ll talk about how it’s really beneficial for people, but then if I’m really trying to sell somebody on it who hates ” homeless people, that’s what I’ll tell them about it.
    39. 39. Project 50
    40. 40. Project 50: Vulnerability Index Developed by Boston Health Care for the Homeless Program
    41. 41. Project 50: Vulnerability Index ✓ More than three hospitalizations or emergency room visits in a year ✓ More than three emergency room visits in the previous three months ✓ Aged 60 or older ✓ Cirrhosis of the liver ✓ End-stage renal disease ✓ History of frostbite, immersion foot, or hypothermia ✓ HIV+/AIDS ✓ Tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical condition Developed by Boston Health Care for the Homeless Program
    42. 42. Individual Population Vulnerability Index the economization of health
    43. 43. Individual Population Vulnerability Index the economization of health
    44. 44. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    45. 45. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    46. 46. The New York Times, 1990-2009 Number of articles on “chronic homelessness” 20 18 16 14 12 10 8 6 4 2 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
    47. 47. The New York Times, 1990-2009 Number of articles on “chronic homelessness” 20 18 16 14 12 10 1998 8 Culhane 6 & Kuhn 4 2 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
    48. 48. The New York Times, 1990-2009 Number of articles on “chronic homelessness” 20 18 16 2002 14 Federal Program 12 10 1998 8 Culhane 6 & Kuhn 4 2 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
    49. 49. The New York Times, 1990-2009 2007 Number of articles on “chronic homelessness” NYC Program 20 18 16 2002 14 Federal Program 12 10 1998 8 Culhane 6 & Kuhn 4 2 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
    50. 50. The New York Times, 1990-2009 2007 Number of articles on “chronic homelessness” NYC Program 20 18 16 2002 14 Federal Program 12 1993 10 Giuliani 1998 8 Statement Culhane 6 & Kuhn 4 2 0 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 19 19 19 19 19 19 19 19 19 19 20 20 20 20 20 20 20 20 20 20
    51. 51. “ I think we have the same interests. The business community in Downtown, some of the leaders are a little bit . . . hard to swallow. But we have the same interests, right? I mean, I don’t think they give a crap about homeless people, but they wanna see no one sleep on the street, and we wanna see no one sleep on the street. ”
    52. 52. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions
    53. 53. From Pathology to Population I. Historical Background II. Chronic Homelessness III. The Vulnerability Index IV. Accidents of Neoliberalism? V. Conclusions

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