Prepared by: Florentina Henry, Community Coordinator for Emmanuel Baptist Church
Presented for Review to: Professor Sean F...
born between 1954 and 1966, with a significantly increased risk for individuals in this age group.(Culhane,
2012)
The vari...
The fact that people experiencing chronic homelessness are most often clientele of other services
provides the opportunity...
andperform background checks, excluding those with certain offenses. Unfortunately, significant numbers of
the chronically...
an assessment tool to prioritize individuals and provide them with “permanent housing with the right supportive
services t...
address the problem of chronic homelessness from within a fragmented system using failed techniques, presents
even more di...
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A Framework for Addressing Chronic Homelessness as a Preventable and Solvable Issue

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White Papers to address the issue of Chronic Homelessness through the lens of seeing it as something that could be solved in the present and prevented in the future. It highlights several programs at the forefront of this new paradigm shift, emerging research into new best practices, and models of collaboration that could make this movement a success.

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A Framework for Addressing Chronic Homelessness as a Preventable and Solvable Issue

  1. 1. Prepared by: Florentina Henry, Community Coordinator for Emmanuel Baptist Church Presented for Review to: Professor Sean Frost, M.A., Soc. 145 on 5/31/2013 Revised for Additional Use on: 6/10/2013 A Framework for Addressing Chronic Homelessness as a Preventable and Solvable Issue Introduction There seems to be a general consensus in the U.S. that homelessness is an unacceptable state, both as one for people to exist in and as one for institutions, both formal and informal, to ignore. Efforts to address homelessness have historically been aimed at its management, yet a growing body of research shows that, at least for some types, greater success can be achieved by focusing on prevention and solution. Chronic Homelessness is a type of homelessness that has been singled out on a national level for prevention and eradication since the year 2000.(Roberts, 2012) This paper will provide a framework to facilitate understanding of the policies, techniques, tools, strategies, and programs being advocated for use toward achieving this goal. What Is Chronic Homelessness? The definition for chronic homelessness that has been agreed upon by the Department of Health and Human Services (HHS), the Department of Housing and Urban Development (HUD), and the Department of Veterans Affairs (VA) for use in determining program eligibility is “an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or has had at least four episodes of homelessness in the past three years.”(Homelessness, 2003) They are single adults facing either a chronic physical or mental illness, developmental disability, substance abuse issue, or some combination of all, with a disproportionate amount being minorities and veterans. A “cohort effect” has been shown for people
  2. 2. born between 1954 and 1966, with a significantly increased risk for individuals in this age group.(Culhane, 2012) The various health issues this sub-group faces are the primary reason they experience homelessness. These issues interfere with their ability to work, and most live in poverty. The main source of income, if any, of a person who is chronically homeless is some form of government assistance, such as Social Security Income or Social Security Disability (SSI/SSD). The average amount received from these sources is rarely enough to provide affordable housing (defined as paying no more than 30% of your gross income on rent and utilities), which the lack of is the secondary reason people are chronically homeless. Most of the chronically homeless reside in urban areas, with particularly high concentrations in California, Texas, Florida, and New York, with California experiencing a rate of four times higher than the next highest state. On a national level, 2-3 million individuals experience some form of homelessness annually, with about 200,000 of those being chronically homeless. (USICH, 2013) What Features of Chronic Homelessness Are Conducive to Prevention and Solution Techniques? A vast majority of resources are already being indirectly used to manage chronic homelessness. There is an exponential margin for cost effectiveness in redirecting these efforts to include permanent housing as part of treatment plans and case managing efforts. For example, Project 25 is a collaboration of social services in San Diego that is using data collection to plot frequent users of services. Some of their findings include: …The chronically homeless represent approximately 24% of the total homeless population in San Diego County, but use 50% of the available resources such as shelters, emergency medical and law enforcement services, mental health support and detox services. 15 of San Diego’s most frequent users of these public resources consumed $1.5 million in medical services alone over 1.5 years-totaling nearly $100,000 per person. In comparison, Housing First has led to a 43% savings in taxpayers in Los Angeles, and in Portland the cost for supportive housing and services is only $26,000 per person.(A Public Engagement Campaign of the United Way of San Diego County, 2009)
  3. 3. The fact that people experiencing chronic homelessness are most often clientele of other services provides the opportunity for nearly all of them to qualify for programs that could be directed to co-address housing concerns, especially the Affordable Care Act (ACA) which begins taking effect next year. The program infrastructure is already there, it is merely a question of linking up appropriate services, sharing funding, and incorporating housing as a critical focus to treating other issues. What Are Barriers to Treating Chronic Homelessness as a Preventable and Solvable Issue? Funding issues are a primary roadblock to switching from a piece-meal system of management to a cohesive approach at treatment. This is not so much a lack of funding, but rather an agreement on its application and distribution including unclear billing and reimbursement policies for when services overlap, distribution of funds being based on arbitrary formulas instead of need, and the use of funding silos. Staffing issues are a barrier to the delivery of quality services. The complex nature of chronic homelessness and its high rate of co-occurring disorders require a level of training, education, and skill that is often found to be lacking, especially in regards to mental health, in the entry-level employees that make up the front line of providers in the health and social service landscape. Staffing shortages, heavy case-loads, low-pay, and stressful and sometimes dangerous working environments contribute to turnover, burnout, and negative staff attitudes.(Jeffery Olivet MA, 2010) Major paradigm shifts are required across all disciplinary fields when treating chronic homelessness. It is a conventional truism to help women and children first. The chronically homeless are single, childless (at least have no children currently accompanying them), and predominantly male. However, families typically have support systems that individuals do not possess, with families being labeled “homeless” who are staying with friends or relatives. Prioritizing families, even those who actually have a stable place to stay, often leads to their placement in an affordable housing option before an individual who is actively living on the street. Stigmas exist for both mental illness and substance abuse including that sufferers are either dangerous or deserving of their plight.Programs often won’t accept clients who are struggling with drugs and alcohol,
  4. 4. andperform background checks, excluding those with certain offenses. Unfortunately, significant numbers of the chronically homeless have criminal histories which correlate with the harsh realities of poverty, street life, substance abuse, and mental illness.(USICH, 2013) What policies, strategies, and tools are being advocated for use in the prevention and solution of chronichomelessness? Opening Doors is an initiative signed by President Obama in 2010 as a continuation of the national agenda started by President Bush to end homelessness in the U.S. This policy contains various objectives and strategies that are of special interest in addressing chronic homelessness.(USICH, 2010) Several policies that have already seen measured success or are being strongly advocated for in programs across the country are Housing First, Low Demand, Priority and Planning, and No Wrong Door. Housing first is the idea that stable, affordable, permanent housing must be a top priority in service planning. It is unrealistic for someone to meaningfully address any other issue while dealing with the dangers, stress, inconveniences, and hardships of homelessness. Low demand is the idea that there should be few, if any restrictions to obtaining housing and the entire process from application to placement should be 30 days or less. The reason for this is tied-in with the idea of housing first. Someone on the street is severely hindered in their ability to meet requirements, obtain documents, keep numerous appointments, etc. and so it does not make sense to have copious restrictions at the onset of treatment when someone is in crisis mode. Priority and Planning is a strategy in which the chronically homeless are specifically targeted for housing and funds are set aside for their use. No Wrong Door is the idea that health and social service agencies should work together to jointly serve clients with complex needs and provide services they qualify for regardless of what was their portal of entry into the system. Prevention strategies are focused on providing services to at-risk persons who stand at recognized entry points to the homeless system, along with building more units of affordable housing, including ones that offer supportive services such as case management.(USICH, 2012). An organization called Common Ground, located in New York City, expanded upon a list of risk factors, known as the Vulnerability Index, and applied them as
  5. 5. an assessment tool to prioritize individuals and provide them with “permanent housing with the right supportive services to fit their needs” with the results being 90% of individuals remaining in said placements after 12 months.(HUD, 2012). A study published in the Journal of the American Medical Association in 2009 showed similar results, revealing that compared to chronically homeless individuals who received standard discharge planning services alone, individuals who were placed in housing with “wraparound intensive case management services” remained housed during the following 18-months at a rate of 75% versus only 15% for the former group.(Commentary by James Dunford, 2009)Initiatives such as the 100,000 Homes Campaign is focusing on the number of new affordable housing units being made available. The Corporation for Supportive Housing (CSH) has had success in its pilot programs with creating permanent supportive housing (PSH) units in concentrated surges in areas with a dense population of chronic homelessness and aggressively targeting these individuals for housing in such units.(Deborah De Santis, 2012) Conclusion In order to shift from the costly and ineffective mode of simply attempting to manage chronic homelessness, and instead move towards prevention and eradication strategies, each community should: be developing a plan to address their own homelessness situation that is linked to state and national efforts, make focusing on chronic homelessness a priority, create networks where social, community, and health services work together to address housing, provide funding agreements for overlapping services, and take measures to ensure quality, accountability, and elimination of staffing issues, implement the policies of Housing First, Low Demand, Priority and Planning, and No Wrong Door, provide strategic surges of affordable housing with supportive services, and continue the use of job-readiness training and supplemental employment programs. This will require extensive communication, shared resources, and unity in vision between the vast networks of service providers within the community. While implementing these tools, philosophy shifts, and partnerships are indeed a daunting task, the reality of the cost in both monetary and human terms of continuing to attempt to
  6. 6. address the problem of chronic homelessness from within a fragmented system using failed techniques, presents even more dismal prospects for one’s community and for the nation as a whole. Works Cited A Public Engagement Campaign of the United Way of San Diego County. (2009, January). Our Progress. Retrieved May 29, 2013, from homeagain: Ending Chronic Homelessness in San Diego: http://homeagainsd.org/our-progress Commentary by James Dunford, D. B. (2009, January). Hospital Resources: A Practical Treatment Plan for Homeless Patients . American Medical Association Journal of Ethics , pp. 19-25. Culhane, D. P. (2012). The Aging of the Adult Homeless Population: Implications for Health and Housing Policy. University of Pennsylvania: The US Interagency Council on Homelessness. Deborah De Santis, P. (2012). Brief Responses to U.S. Interagency Council Report on Chronic Homelessness. New York: Corporation for Supportive Housing. Homelessness, S. W. (2003). Ending Chronic Homelessness: Strategies for Action. Washington, D.C.: U.S. Department of Health and Human Services, Tommy G. Thompson [former] Secretary. HUD, U. D. (2012, Summer). Linking Housing and Health Care Works for Chronically Homeless Persons. Retrieved May 25, 2013, from Evidence Matters: transforming Knowledge into Housing Community Development Policy: http://www.huduser.org/portal/periodicals/em/summer12/highlight3.html Jeffery Olivet MA, S. M. (2010, April). Staffing Challenges and Strategies for Organizatons Serving Individuals who have Experienced Chronic Homelessness. The Journal of Behavioral Health Services and Research, pp. Vol. 37:2 pg 226-237. Now on PBS. (2009, June 26). Facts and Figures: The Homeless. Retrieved May 29, 2013, from Now on PBS: pbs.org/now Roberts, J. J. (2012, April 2). Did America's 10-Year Plan to End Homelessness Work? Retrieved June 2, 2013, from The Huffington Post: http://www.huffingtonpost.com/joel-john-roberts/did-americas-ten-year-pla_b_1394905.html USICH. (2010). Opening Doors: Federal Strategic Plan to Prevent and End Homelessness. Washington, D.C.: HUD Secretary and USICH Chair Shaun Donovan. USICH. (2012, April). Chronic Homelessness in Focus. Retrieved May 25, 2013, from United States of Interagency Council on Homelessness: http://www.usich.gov/population/chronic/in_focus/ USICH. (2013). People Experiencing Chronic Homelessness. Retrieved May 5, 2013, from United States Interagency Council on Homelessness: http://www.usich.gov/population/chronic USICH. (2013). State Homeless Resources Map. Retrieved May 25, 2013, from United States Interagency Council on Homelessness: http://www.usich.gov/usich_resources/maps/overall_homelessness_rates

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