1. SPA 3 & 4 PROFILE
ASSESSING THE PREVALENCE OF WOMEN
AND CHILDREN IN SKID ROW
A Rapid Assessment Survey
Los Angeles County Department of Health Services • Public Health
June 2003
SPA 3 & 4 BEST PRACTICE COLLECTIONRELIABLE INFORMATION FOR EFFECTIVE COMMUNITY HEALTH PLANS, PROGRAMS AND POLICIES
M. RICARDO CALDERÓN, SERIES EDITOR
San Gabriel Valley and Metropolitan Service Planning Area Health Office (SPA 3 & 4 )

2. June 2003
SAN GABRIEL VALLEY SERVICE PLANNING AREA (SPA 3)
METROPOLITAN SERVICE PLANNING AREA HEALTH OFFICE (SPA 4)
241 North Figueroa Street, Room 312
Los Angeles, California 90012
(213) 240-8049
The Best Practice Collection is a publication of the
San Gabriel Valley (SPA 3) and Metropolitan Ser-
vice Planning Area (SPA 4). The opinions expressed
herein are those of the editor and writer(s) and do
not necessarily reflect the official position or views
of the Los Angeles County Department of Health
Services. Excerpts from this document may be
freely reproduced, quoted or translated, in part or
in full, acknowledging SPA 3 & 4 as the source.
Internet: http://www.lapublichealth.org/SPA 3
Internet: http://www.lapublichealth.org/SPA 4
LOS ANGELES COUNTY
BOARD OF SUPERVISORS
Gloria Molina, First District
Yvonne Brathwaite Burke, Second District
Zev Yaroslavsky, Third District
Don Knabe, Fourth District
Michael D. Antonovich, Fifth District
DEPARTMENT OF HEALTH SERVICES
Thomas L. Garthwaite, MD.
Director and Chief Medical Officer
Jonathan E. Fielding, MD, MPH, MBA.
Director of Public Health and County Health Officer
James Haughton, MD, MPH.
Medical Director, Public Health
BEST PRACTICE COLLECTION TEAM
M. Ricardo Calderón, Series Editor
Manuscript Author & SPA 4 Area Health Officer
Christopher Corniola, MPH.
Manuscript Author & Epidemiology Analyst
Angela Salazar, MPH.
Manuscript Author & Program Director, Health Education
Carina Lopez, MPH.
Project Manager, Information Dissemination Initiative
Photo: Courtesy of
At a Glance
The SPA 3 & 4 Best Practice Collection fulfills the Los Angeles County
Department of Health Services (DHS) local level goal to restructure and
improve health services by“establishing and effectively disseminating to
all concerned stakeholders comprehensive data and information on the
health status, health risks, and health care utilization of Angelinos and
definable subpopulations”.1
It is a program activity of the SPA 3 & 4 Infor-
mation Dissemination Initiative created with the following goals in mind:
To highlight lessons learned regarding the design, implementation,
management and evaluation of public health programs
To serve as a brief theoretical and practical reference for program
planners and managers, community leaders, government officials,
community based organizations, health care providers, policy mak-
ers and funding agencies regarding health promotion and disease
prevention and control
To share information and lessons learned in SPA 3 & 4 for community
health planning purposes including adaptation or replication in other
SPA’s, counties or states
To advocate a holistic and multidimensional approach to effectively
address gaps and disparities in order to improve the health and
well-being of populations
The SPA 3 & 4 Information Dissemination Initiative is an adaptation of the
Joint United Nations Program on HIV/AIDS (UNAIDS) Best Practice Collec-
tion concept. Topics will normally include the following:
1. SPA 3 4 Viewpoint: An advocacy document aimed primarily at policy
and decision-makers that outlines challenges and problems and pro-
poses options and solutions.
2. SPA 3 4 Profile: A technical overview of a topic that provides infor-
mation and data needed by public, private and personal health care
providers for program development, implementation and evaluation.
3. SPA 3 4 Case Study: A detailed real-life example of policies, strategies
or projects that provide important lessons learned in restructuring
health care delivery systems and/or improving the health and well be-
ing of populations.
4. SPA 3 4 Key Materials: A range of materials designed for educational
or training purposes with up-to-date authoritative thinking and know-
how on a topic or an example of a best practice.
2
Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile

3. Improving DHS Performance: SPA 4 ViewPoint June 2003Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile
I. INTRODUCTION 4
II. BACKGROUND INFORMATION 5
III. RAPID RESEARCH METHODOLOGY 5
1. Women and Children Profile xx
2. Shelter Profile/Childcare Facility Profile
IV. FINDINGS AND RESULTS 6
1. Overall xx
2. Shelter and Childcare Facilities xx
i. Union Rescue Mission 7
ii. The Ford Hotel 8
iii. Para Los Niños 8
V. DISCUSSION AND RECOMMENDATIONS 9
VI. FIGURES AND TABLES
1. Racial Composition of Survey Participants (all) 6
2. Racial Composition of Survey Participants (adults) 6
3. Racial Composition of Survey Participants (children) 7
4. Racial Composition of SPA 4 Residents 7
VII. REFERENCES 9
33
ASSESSING THE PREVALENCE OF WOMEN AND CHILDREN IN SKID ROW
Table of Contents

4. Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile June 2003
INTRODUCTION
4
I. INTRODUCTION
Over the past few years, the United
States has experienced times of great
prosperity, wealth and economic
growth to times of budget shortfalls,
job losses and economic decline.
With the decline in the economy, an
increase in unemployment is seen
locally and throughout the country.
Unemployment rates have climbed
to 6.7% in California and 6.8% in Los
Angeles County (LAC). Lack of safe,
affordable housing is also a con-
cern in addition to unemployment
as a cause of homelessness in Los
Angeles. Currently, the fair-market
rent for a one-bedroom apartment
in Los Angeles is $746.00 per month
plus the cost of utilities for a total per
year over $9,000.00. For a family of
four living in poverty (100% Fed-
eral Poverty Level for a family of 4 is
$18,400.00) , this is approximately
half of their annual income and little
money for other expenses is available
such as childcare, food, healthcare,
etc. Another option for low-income
families is Section 8 low-income
housing. According to the Los
Angeles County Housing Authority,
the waiting list for Section 8 housing
has 120,000 eligible families with a
wait time of approximately 8 years.
In fact, there are families currently
on the Section 8 housing list who
have been there since 1988. With the
rise in unemployment, the current
instability of the economy and the
housing shortage there is an increase
in the homeless population in Los
Angeles County. The exact number of
homeless people is not known due
to difficulties measuring an extreme-
ly transient population. However,
recent data estimates that 84,000
people are homeless each night on
the streets of Los Angeles.
Homelessness in America is the result
of an interaction between many
circumstances including, but not
limited to, the supply of affordable
housing, poverty, unemployment and
disability. Other factors include the
following:
• Substance abuse, mental illness
and the lack of needed services
• Low paying jobs
• Domestic violence
• Change and cuts in public assis-
tance
• Changes in family structure
• Chronic health problems and lack
of access to affordable health care
While it is clear that homelessness is
a national problem, it is important
to understand that the homeless
population in the United States is not
homogeneous and risk factors lead-
ing to homelessness vary between
geographic areas.
The homeless population in Los
Angeles County and the United States
comprises mainly of single men with-
out children or families. According to
a study conducted by the Institute
for the Homeless and Poverty at The
Weingart Center in June 2000 5
, the
homeless population consists of 66%
single adults and 34 % families. Of
the homeless single adults, 77% are
men and only 23% are women. How-
ever, over the last several years there
has been a noticeable increase in the
number of women and children that
become homeless throughout locally
and nationally. Currently, one-fourth
of the homeless are women with
children in the United States.
Although several studies have been
conducted on homeless women liv-
ing in Skid Row, the data is limited. A
study conducted in July 2001 by the
Downtown Women’s Action Coalition
(DWAC)* surveyed over 400 women.
The data showed that the majority
of women were African American
(63%), 13% were non-Hispanic white
and 11% Hispanic. Additionally, 38%
of the women surveyed had children
under the age of 18 and only 38% had
custody of their children. Two-thirds
of the women with custody had their
children currently living with them.
The study also found that over 85% of
the women had one source of income
or public benefit.
As the number of women and chil-
dren living in and around Central City
East rises the need for childcare rises
also. In Central City East Los Ange-
les, quality and affordable childcare
is difficult if not impossible to find.
The average cost of childcare in Los
Angeles is $650 per month for infants
and $500 per month for children
ages of 2-5 years. In Metropolitan Los
Angeles (SPA 4), an estimated 48% of
residents live below the federal pov-
erty level and 8% report being home-
less at least once in the last 5 years.
These families do not make enough
money to cover rent and food each
month and cannot afford the added
cost of childcare. With limited alterna-
tives and very little income, children
are left alone for many hours without
adult supervision while their parent(s)
work and/or look for sustenance and
work.

5. Improving DHS Performance: SPA 4 ViewPoint June 2003Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile
BACKGROUND INFORMATION RAPID RESEARCH METHODOLOGY
55
II. BACKGROUND
INFORMATION
Central City East, formerly referred to
as“Skid Row”is located in downtown
Los Angeles. It is a 50-block area
bounded by Third Street on the north,
Alameda Street on the east, Seventh
Street on the south and Main Street
on the west. The area is populated
with a large number of homeless
residents.
“Skid Row”is polluted with trash and
debris on the streets and sidewalks.
Although portable toilets are avail-
able, the area smells of urine and
body odor. In recent years, the num-
ber of encampments (tents and card-
board box houses) has decreased.
However, they are still a familiar part
of the Central City East landscape.
Transients normally gather on the
streets and loiter during the daytime.
The most common areas are directly
in front of the missions located in the
area. The majority of the homeless
carry their belongings in garbage
bags and only a few push shopping
carts. During the evening hours, the
mission emergency shelters are full
with transients seeking a place to
sleep.
The Service Planning Area 4 (SPA
4) Area Health Office created a
rapid assessment tool to assess the
prevalence of women and children
in Central City East. The purpose of
this assessment was to more accu-
rately describe this population and
provide the SPA 4 Management and
field Public Health Nurses with a
more accurate picture of the women
and children on“Skid Row”aimed to
develop strategies to improve their
health status and wellbeing.
III. RAPID RESEARCH
METHODOLOGY
1. PROFILE OF WOMEN AND
CHILDREN
In June 2003, a survey of 52 families
living in temporary housing in Central
City East was conducted totaling 106
participants. The survey comprised of
the traditional Public Health Nursing
(PHN) Assessment Form and 14 ques-
tions about quality of life specifically
developed for this project. These
questions inquired basic demo-
graphic information not collected by
the PHN form and information about
experiences while living in shelters or
missions. No sensitive nature ques-
tions were included; however, partici-
pants were informed about their right
to refuse to answer any question.
Each survey question was read aloud
to participants to avoid illiteracy is-
sues. The administration of the survey
took approximately 20 to 30 minutes
for each family, depending on the
number of family members.
2. SHELTER/CHILD CARE FACILITY
PROFILE
Additional surveys were created to
assess the capacities of shelters and
childcare facilities in the Skid Row.
Questions were developed to gain an
understanding regarding the enroll-
ment policies of shelters and child-
care facilities, basic demographics of
clients and staffing at these facilities.
A total of 3 facilities were surveyed
-Union Rescue Mission, Ford Hotel
and Para Los Niños.
Facts About the Homeless
Population in Los Angeles:
Approximately 82,000 people are homeless
on any given night in Los Angeles County.
Homeless people may be found throughout
the county,the largest percentages are in
South Los Angeles and Metro Los Angeles
(SPA 4) .
The average age is 40 - women tend to be
younger.
33% to 50% are female. Men make up about
75% of the single population.
About 42% to 77% do not receive public
benefits to which they are entitled.
20% to 43% are in families,typically headed
by a single mother.
An estimated 20% are physically disabled.
41% of adults were employed within last
year.
About 25% are mentally ill.
As children,27% lived in foster care or group
homes;25% were physically or sexually
abused.
33%-66% of single individuals have
substance abuse issues.
48% graduated from high school;32% had
a bachelor degree or higher (as compared to
45% and 25% for the population overall
respectively).
Institute for the Study of Homelessness
Poverty at the Weingart Center,June 2000

6. Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile June 2003
Figure 1. Racial Composition of Survey Participants (all)
Figure 2. Racial Composition of Survey Participants (adults)
IV. FINDINGS AND RESULTS
1. OVERALL
The overall racial composition of
those who completed the survey was
as follows: 45.3% Hispanic, 40.1%
African American, 3.8% White, and
7.5% unknown (Figure 1). Specifically,
adults surveyed, reported being Af-
rican American 51.8%, Hispanic 17%,
White 4%, and 5% did not answer
(Figure 2). This distribution was much
different than the ethnic composition
of Metropolitan Los Angeles (SPA 4 )
where 55% are Hispanic, 22% White,
and 6% African American (Figure
4). The reasons for this discrepancy
could not be determined due to the
limitations of the survey. The median
age of adults surveyed was 39.5 years
ranging from 21 to 72 years. The
majority of participants were single
(69.6%) and 12.5% were married.
Women with children comprised of
40.4% of those surveyed and had an
average of 2.7 children. The average
length of stay in the shelters was 6.9
months. The average monthly income
of adults was $191.00. Sources of in-
come included, but were not limited
to, AFDC (12%), government relief
(23.2%), and supplemental security
income (17.9%).
The characteristics of the children
living in Central City East vary greatly
from the adults. According survey
findings, children living Skid Row
were predominantly Hispanic (64%)
and 30% were African American (Fig-
ure 3, page 7). None of the children
surveyed were White. The average
age of the children was 6 years and
56% were female (Figure 5, page 8).
The majority of children had health
insurance (82%) and 54% had a pri-
mary care physician.
FINDINGS AND RESULTS
6

7. Improving DHS Performance: SPA 4 ViewPoint June 2003Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile
7
2. SHELTER/CHILDCARE FACILITIES
2.1. UNION RESCUE MISSION
Union Rescue Mission (URM),
founded by Lyman Stewart, Presi-
dent and Founder of the Union Oil
Company, first opened its doors
in 1891. URM is a 750-bed shelter
located in Central City East at 545
South San Pedro Street. This shelter is
the largest Christian Rescue Mission
in the United States and houses over
230,000 people annually. URM is the
only emergency shelter in Los An-
geles that is open 24 hours per day,
every day of the year. Additionally, it
is the only shelter in Los Angeles that
accepts women and children without
restrictions on the age or number of
children. Mothers with sons up to and
including 17 years of age are housed
in the women/children emergency
shelter. Males age 18 years and older
are placed in the men’s shelter.
The shelter was home to approxi-
mately 107,000 women, children and
families in 2002. This represents 46%
of the overall resident population at
the shelter. Currently, 118 children
reside at URM. The average length of
stay for tenants is 6 months to 1 year
and more than 195,000 women and
children were served meals at this fa-
cility in 2002. The URM management
and staff have seen many changes
in the clientele over the last several
years. For example: (a) an increase in
the number of Hispanic homeless, (b)
an increase in the number of African
American families with small children,
and (c) an increase in the number of
single women. Additionally, an in-
crease in upper respiratory infections,
rashes, and ear and throat infections
has been seen among children in
residence.
Figure 3. Racial Composition of Survey Participants (children)
Figure 4. Racial Composition of SPA 4 Residents
FINDINGS AND RESULTS

8. Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile June 2003
2.2. THE FORD HOTEL
The Ford Hotel/Shelter is a six story
Single Residence Occupancy (SRO)
building with 288 rooms and 48
rooms on each floor. At the present
moment, 260 rooms are occupied.
Each room has a window, concrete
floors, a bed, a sink and a dresser.
Some rooms are equipped with extra
furniture to accommodate additional
children. The rooms in this facility
are not equipped with bathrooms,
kitchens or refrigerators; however,
residents are allowed to bring their
own refrigerator. No food services
are available to the residents and
there are a few vending machines
that dispense chips, candy and soda
on the 1st floor. Clients are required
to complete an application, provide
proof of income and present a valid
California ID in order to secure a
room in this facility. Room rates vary
and are determined by the size of
the family. A basic, single occupancy
room starts at $125.00 per week with
an additional $5.00 rental fee. The
rate does not change if the room is
rented by the month versus by the
week. Residents at the Ford Hotel/
Shelter are families with and with-
out children, single women and
single men. An estimated 90% of the
residents are families with children
averaging 3 to 4 children per family.
There are over 180 children residing
in this shelter. Residents live in this
hotel for 1 to 2 years. Most of these
residents are currently on the waiting
list for Section 8 housing which, as
mentioned above, consists of 120,000
families and an average wait time of
8 years.
2.3. PARA LOS NIÑOS
Para Los Niños is a low cost/no cost
day care facility located in downtown
Los Angeles. This facility provides
childcare services to families that live
in the downtown Los Angeles. Most
families are extremely low income
and can not afford child care costs.
During the last fiscal year, 98.7% of
clients had incomes below the pov-
erty line --average monthly income
below $1,100 for a family of four.7
In order for children to enroll in this
facility, parents must be working and/
or receiving training or schooling and
must provide income tax verification.
For most families, enrollment at Para
Los Niños is free; however, some pay
between $2.00 and $6.90 per week
per child. Financial aid is available to
families who are unable to pay this
out of pocket. The children must be
current on all immunizations and
must have a social security number,
physical exam, and a current tubercu-
losis test.
Figure 5. Gender of Children Surveyed.
Para Los Niños enrolls a maximum of
120 children and is at maximum enroll-
ment. The teacher/child ratio is fairly
low at 1:3 for infants, 1:4 for toddlers
and 1:8 for both early preschool and
preschool. The majority of the children
in attendance are between 3 and 5
years of age (80%). All of the children
currently enrolled are Hispanic and the
male to female ratio is 1:1. Children
who enroll at Para Los Niños are given
2 meals per day (breakfast and lunch)
and an afternoon snack. In addition to
offering low cost/no cost childcare, this
day care facility offers other services
to its clients such as referrals to social
services, case management, legal as-
sistance, housing assistance, parenting
classes, child abuse prevention, mental
health services and advocacy support.
Additionally, food, clothing, tokens,
and vouchers are available to client
families.
FINDINGS AND RESULTS
8

9. Improving DHS Performance: SPA 4 ViewPoint June 2003Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile
V. DISCUSSION AND
RECOMMENDATIONS
As previously described, Central City
East, formerly known as“Skid Row”,
is a 50-block area in downtown Los
Angeles characterized by the pres-
ence of large numbers of homeless
people. Not long ago, it was difficult
to find women and children in Central
City East. Although men still make up
the majority of the homeless popu-
lation, women with children is the
fastest growing population group of
homeless people.6
The women and
children who were surveyed would
benefit from interventions, services,
agencies targeting solely their issues
and concerns. Programs, services
and resources for domestic violence
prevention, financial management, job
skills and training, health education,
mental health and substance abuse
counseling, childcare, and parent-
ing are needed. If the current trend
continues, an increase in the numbers
of women and children is expected in
Central City East.
The homeless population in the United
States is one of great diversity and
fluidity. It is important that agen-
cies devoted to provide services and
resources to the homeless popula-
tion understand that risk factors for
homelessness and the people them-
selves vary from geographic area to
geographic area. The development of
programs based on broad perspectives
of homelessness may not provide a
real benefit to this population. In addi-
tion, the notion that a single organiza-
tion can meet all of the needs of this
population is inappropriate and true,
strategic alliances and partnerships
between public, private and non-profit
agencies are needed to (1) strengthen,
expand and diversify programs and
services, (2) generate adequate finan-
cial resources to address specific social
and health issues, (3) escalate efforts
to prevent the growing homelessness
trend among women and children,
(4) make a real impact on the state of
the homelessness in Central City East
and (5) improve the health status and
wellbeing of the homeless.
REFERENCES
1. State of California Department of
Labor website. http://www.calmis.
ca.gov
2. Reeve T. Schley.“Poverty on Rise
Here.”Santa Monica Mirror. 8 July
2003.
3. 2003 Federal Poverty Guidelines
4. Los Angeles County Housing
Authority. Telephone interview
conducted by author. 20 June 2003.
5. Paul Tepper, Jessica Barrett
Simpson and Eva Johnson, Poverty
in Los Angeles, Institute for the
Study Homelessness and Poverty at
the Weingart Center (Los Angeles).
6. The Good Samaritan Crisis Model
Network for Women with Children.
http://www.helpforwomen.org/
statistic.htm
7. Para Los Niños website. http://
www.paralosninos.org
8. Union Rescue Mission website.
http://www.unionrescuemission.org
DISCUSSION AND RECOMMENDATIONS
9

10. Assessing the Prevalence of Women and Children in SKID Row: SPA 3 4 Profile June 2003
San GabrielValley Service Planning Area (SPA 3)
Metropolitan Service Planning Area (SPA 4)
241 North Figueroa Street, Room 312
Los Angeles, California 90012
Tel: (213) 240-8049
Fax: (213) 202-6096
www.lapublichealth.org
© 2003 SPA 3 4