Homelessness in Knoxville and Knox County, 2011-2012

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 ii
Knoxville-Knox County Homeless Coalition
Rev. Dr. Bruce Spangler, President
KKCHCoalition@gmail.com
Knoxville Homeless Management Information System
David A. Patterson, Ph.D., Director
dpatter2@utk.edu
Contact Information
Roger
Nooe,
Ph.D.

Professor
Emeritus,
UT-‐College
of
Social
Work

Director
of
Social
Services,
Community
Law
Office

rnooe@pdknox.org

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 iii
Table of Contents
Acknowledgements..............................................................................................................v
Note to the Reader ............................................................................................................. vi
Introduction....................................................................................................................... vii
Interviewers..........................................................................................................................x
Section I
Defining Homelessness........................................................................................................1
Numbers...................................................................................................................1
Review of Contributing Factors...........................................................................................4
Housing................................................................................................................................5
Current Economic Crisis......................................................................................................7
Mental Illness & Deinstitutionalization...............................................................................7
Employment.........................................................................................................................9
Substance Abuse..................................................................................................................9
Education ...........................................................................................................................11
Personal Crises...................................................................................................................11
Other Risk Factors .............................................................................................................13
Homelessness as a Lifestyle...............................................................................................15
Section II
Executive Summary...........................................................................................................16
2011 KnoxHMIS Annual Report.......................................................................................18
New Clients Entered into KnoxHMIS...................................................................18
Active Clients Utilizing Services...........................................................................19
Basic Demographic Information on Active Clients...............................................21
Disability Status of Active Clients.........................................................................22
Self-Reported Primary Reason for Homelessness.................................................23
Subpopulations of Active Clients ..........................................................................24
Chronic Homelessness...............................................................................24
Veterans .....................................................................................................27
Female Single Parents................................................................................27
Street Homeless .........................................................................................28
Children......................................................................................................28
Services Capture in KnoxHMIS ............................................................................29
Emergency Shelter & Transitional Housing..........................................................30
Housing Outcomes.................................................................................................30
Permanent Supportive Housing .............................................................................31
Homelessness Prevention & Rapid Rehousing Program.......................................31
Casenotes ...............................................................................................................32
Maps of Zip Codes.................................................................................................33
KnoxHMIS Data Quality.......................................................................................36
AHAR Participation...............................................................................................37
Director’s Commentary .........................................................................................37

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 iv
Knoxville-Knox County Homeless Coalition Biennial Study...........................................39
Design ................................................................................................................................39
Demographics ....................................................................................................................40
Roots ..................................................................................................................................42
Family ................................................................................................................................43
Military Service .................................................................................................................44
Causes of Homlessness......................................................................................................45
Housing..............................................................................................................................46
Employment.......................................................................................................................46
Health.................................................................................................................................48
Mental Health.....................................................................................................................49
Alcohol & Other Drugs......................................................................................................50
Crime..................................................................................................................................51
Life on the Streets..............................................................................................................52
Women...............................................................................................................................55
Commentary.......................................................................................................................59
Section III
Resources in Knoxville......................................................................................................61
References..........................................................................................................................69

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 v
ACKNOWLEDGEMENTS

Homelessness
in
Knoxville/Knox
County:
2012
represents
twenty-‐six
years
of
studies

sponsored
by
the
Knoxville/Knox
County
Homeless
Coalition.

Homelessness
continues
to
be

a
major
problem
in
East
Tennessee.

Many
dedicated
people
are
working
toward
finding

solutions.

We
are
indebted
to
their
help
in
conducting
this
study
as
well
as
previous
ones.

The
interviewers
who
helped
contribute
their
time
and
skills
deserve
a
special

thanks.

The
agency
executives,
Major
Don
Vick,
Burt
Rosen,
Ginny
Weatherstone,
Fr.
Ragan

Schriver,
Patrick
White,
Dan
Hoxworth,
Marigail
Mullin,
Sheila
Pellasma,
Maxine
Raines,

Barbara
Kelly,
Preacher
Bob
Burger,
and
Joyce
Shoudy
were
supportive
of
the
study.

Jamie

Brennan,
Dr.
David
Patterson,
Mary
Lou
Hammer,
Rev.
Dr.
Bruce
Spangler
and
Gabrielle

Cline
were
tremendous
resources
in
planning
and
conducting
the
study.

Shelter
and

agency
staff-‐-‐Larry
Lindsey,
Treva
Jerigan,
Donna
Wright,
Rev.
Mychal
Spence,
Cynthia

Russell,
Barbara
Davis,
Becky
Nolan,
Keith
Farrar,
Beverly
Lakin,
Rick
Walker,
Stephanie

Goodman,
Susan
Cashion,
Greg
Lay,
Mimi
Vivio,
and
Alle
Lily
were
most
cooperative
and

helpful
in
our
data
collection.

The
Homeward
Bound
staff,
Barbara
Disney,
Erin
Lang,
Sissy

Flack,
and
Beatrice
Irwin
did
extra
work
in
interviewing
and
assisting
with
the
study.

Carl

Williams
and
Roosevelt
Bethel
were
essential
in
surveying
outside
locations.

My
colleagues
at
the
Community
Law
Office,
Matt
Silvey
Chris
Smith
and
Phillip

Carrigan
were
very
helpful.

My
graduate
students,
Jennifer
Smith,
Lindsay
Preskenis,
Jaime

Frimpong,
and
Brad
Jennings
conducted
interviews
and
helped
as
needed.

A
special
thank

you
goes
to
my
secretary,
Marybeth
Snyder.

Mark
Stephens,
Knox
County
Public
Defender,

has
provided
countless
resources
and
allowed
us
to
use
meeting
rooms
for
interviewer

training.

Mike
Dunthorn,
project
director
of
the
Ten
Year
Plan
to
End
Chronic
Homelessness,

was
instrumental
in
sponsoring
this
study.

The
City
of
Knoxville
provided
support
for
the

study.

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 vi
Note
to
the
Reader

“Imagination
is
more
important
than
information.”

Albert
Einstein

“As
long
as
leaders…base
their
confidence
on
how
much
data
they
have
acquired,
they
are

doomed
to
feel
inadequate,
forever.”

Edwin
Friedman

Before
I
venture
into
the
relevance
of
Albert
Einstein’s
preference
for
imagination

and
Friedman’s
suggestion
of
the
“paralysis
of
analysis”
for
the
2012
Knoxville/Knox

County
Homeless
Study,
I
must
begin
by
expressing
my
immense
gratitude
to
everyone

who
has
made
this
study
possible.

Many
individuals
offered
so
much
energy
to
make

this
document.

I
would
be
remiss
in
attempting
to
name
everyone
because
I
am
sure

that
I
may
inadvertently
overlook
the
contribution
of
someone.

So
I
offer,
instead,
a

wide
“blanket”
of
thanks
and
gratitude
to
all
of
those
whose
hands
and
hearts
are

responsible
for
the
compilation
of
this
2012
study.

However,
I
would
be
further
remiss
not
to
mention
Dr.
Roger
Nooe
and
Stacia

West.

Dr.
Roger
Nooe,
University
of
Tennessee
Professor
Emeritus,
College
of
Social

Work
and
Director
of
Social
Services
of
the
Knox
County
Public
Defenders
Office,
has

once
again
assumed
the
role
as
the
principal
investigator
for
the
study.

This
is
a
role

that
he
has
fulfilled
with
unquestionable
integrity
and
scholarly
passion
for
the
past
two

and
a
half
decades.

Though
the
Knoxville/Knox
County
Homeless
Coalition

commissions
the
study,
Dr.
Nooe
has
fully
earned
the
distinction
and
rightful
claim
by

most
that
this
study
is
really
“Roger’s
study.”

In
an
attempt
to
compliment
yet
contrast
the
findings
and
discoveries
of
this

study
and
the
University
of
Tennessee’s
College
of
Social
Work’s
Annual
Report
of

Homelessness
from
the
data
of
the
Homeless
Management
Information
System
(HMIS),

Stacia
West,
Data
Analyst
with
KnoxHMIS,
accepted
the
Coalition’s
invitation
to
join

efforts
with
Dr.
Nooe
for
the
compilation
of
this
study.

Her
technological
and
analytical

skills
and
competencies
have
few
equals.

Therefore,
I
pause
to
extend
an
additional
thanks
to
Roger
and
Stacia,
“Thanks!”

This
study
is
a
window
into
homelessness
in
the
Knoxville/Knox
County
area.
The

results
and
conclusions
are
found
within,
so
I
do
not
wish
to
repeat
or
rehearse
any
of

them.

The
results
and
conclusions
speak
for
themselves
and
in
the
end
will
find

multiple
and
varied
voices
in
their
interpreters
and
challengers.

You
shall
find
within

these
covers
a
lot
of
data,
information
and
some
extrapolations.

Yet,
my
note
to
you
is
far
from
passive
in
character
and
intent.

If
Einstein’s

insight
has
any
validity
or
worthiness
of
imitation,
then
I
propose
that
you
use
the

“imaginative
and
creative”
force
that
you
possess
to
translate
this
data
into
actionable

insights
and
proposals.

The
collection
of
data
in
this
document
is
well
worth
paying

attention
to
because
YOU
can
use
it
as
a
catalyst
for
change
in
the
way
our
community

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 vii
responds
to
and
with
the
individuals
whose
identity
is
temporarily
“hijacked”
by
the

experience
of
homelessness!

If,
however
and
on
the
other
hand,
the
“facts
and
figures”

herein
are
just
another
proliferation
of
information,
then
the
addictive
stupor
of
data

collection
has
once
again
mesmerized
us
into
nonaction.

In
his
book,
A
Failure
of
Nerve,
Edwin
Friedman
notes
how
the
proliferation
of

information
will
often
paralyze
leaders.
No
doubt,
the
flow
and
volume
of
information
is

relentless
and
ceaseless.

To
assume
that
one
can
“corral”
all
the
data
needed
on

homelessness
before
drawing
decisive
and
definitive
proposals
is
delusional,
and

effectively
impedes
any
sense
of
change
or
progress.
The
purpose
for
the
collection
of

data
in
this
volume
has
its
main
objective
and
only
purpose:
to
bring
an
end
to
chronic

homelessness
and
shorten
any
experience
of
homelessness
for
children,
women
and

men
in
our
communities.

I
believe
that
with
an
informed
and
measured
balance
of
personal
responsibility

and
systematic
change,
future
studies
will
reflect
that
the
Knoxville/Knox
County
area
is

an
imaginative
landscape
of
purposeful
leaders,
advocates
and
system
changers
with

many
individuals
reclaiming
both
their
names
and
identity
from
the
clutches
of

homelessness.

Please
receive
this
2012
study
as
a
gift
from
the
Knoxville/Knox
County
Homeless

Coalition
to
you
and
our
community
partners.

I
write
respectfully
and
sincerely,

Rev.
Dr.
Bruce
W.
Spangler,
President

Knoxville/Knox
County
Homeless
Coalition

“The
mission
of
the
Knoxville/Knox
County
Homeless
Coalition
is
to
foster
collaborative

community
partnerships
in
a
focused
effort
that
seeks
permanent
solutions
to
prevent,

reduce
and
end
homelessness.”

adopted
January
27,
2009

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 viii

INTRODUCTION

Homelessness
in
Knoxville-‐Knox
County
2011-‐2012
is
the
fifteenth
study
of

homelessness
in
Knoxville-‐Knox
County
sponsored
by
the
Knoxville-‐Knox
County

Homelessness
Coalition
and
highlights
twenty-‐six
years
of
collecting
data.

The
first

study
was
conducted
in
1986
with
regular
studies
conducted
biennially
thereafter,
plus

two
smaller
intermediate
studies.

When
initially
appointed
in
November
1985
as
the

Knoxville
Coalition
for
the
Homeless,
the
coalition
was
charged
with
three
major

responsibilities:
(1)
to
ascertain
the
extent
of
homelessness
in
Knoxville,
(2)
to

determine
services
available
to
the
homeless
and
make
recommendations
concerning

deficient
or
nonexistent
services,
and
(3)
to
increase
communication
and
coordination
of

services
among
existing
agencies
and
organizations
working
with
the
homeless.

The

coalition
continues
to
meet
on
a
monthly
basis
and
in
addition
to
sponsoring
studies,

serves
as
a
forum
for
exchange
of
ideas
and
information.
It
has
taken
an
increasingly

active
community
role
through
public
education
activities,
supporting
implementation
of

the
Ten
Year
Plan
to
End
Chronic
Homelessness,
and
developing
housing
for
the
homeless.

In
July
2011,
the
Coalition
adoped
the
following
permanent
solutions
to
prevent,

reduce,
and
end
homelessness:

HOUSING
ACCESSIBILITY

1)

Develop
a
range
of
permanent
housing
options
to
include
permanent

supportive
housing
and
appropriate
levels
of
support
based
on
individual
need.

2)

Transitional
housing
options
for
special
populations
(for
example,
families

with
children,
youth
aging
out
of
foster
care,
etc.).

3)

Community
integration
–
availability
of
housing
throughout
the
community,

neighborhoods
become
more
accommodating.

SUPPORTIVE
SERVICES

1)

Increased,
timely
access
to
alcohol
and
drug
treatment
services
and

community
based
mental
health
services.

2)

Expanding
case
management
services
to
those
at
risk
of
homelessness,
such

as
residents
in
family-‐style
public
housing.

3)

More
funding
for
utility
and
rent
assistance
to
prevent
evictions.

PROACTIVE
COMMUNITY
RESPONSE

1)

Advocating
for
changes
in
interpretation
and
implementation
of
commitment

for
treatment
criteria
(i.e.
Title
33)
to
ensure
that
both
inpatient
and
outpatient

treatment
is
available
to
persons
in
psychiatric
crisis
and/or
situations
that
pose

a
risk
of
harm.

2)

Expanding
the
capacity
for
services
that
are
already
proven
to
work
–
case

management,
subsidized
housing,
etc.

3)

Better
coordination
of
systems
and
resources
to
prevent
discharging
to
the

streets
from
jail,
hospitals
and
foster
care.

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 ix
A
number
of
significant
activities
continue
in
Knoxville-‐Knox
County.

The
Ten

Year
Plan
to
End
Chronic
Homelessness
developed
at
the
request
of
Knoxville
Mayor
Bill

Haslam
and
Knox
County
Mayor
Mike
Ragsdale
represents
the
first
community
plan
to

address
homelessness
in
a
comprehensive,
coordinated
manner.
The
plan’s
central

theme,
Housing
First,
is
a
different
approach
to
homelessness
and
builds
on
agencies’

efforts
that
have
evolved
to
get
persons
out
of
homelessness
rather
than
focusing
on

easing
their
discomfort
on
the
streets.
Previous
studies
have
noted
the
changing

orientation
of
shelters
and
agencies,
from
providing
emergency
or
crisis
services
to

assisting
homeless
persons
to
become
stabilized
in
permanent
housing.
In
addition,

Mayors
Daniel
Brown
and
Tim
Burchett
appointed
the
Compassion
Knoxville
Task

Force,
which
helped
gather
and
organize
public
opinion
on
homelessness
in
our

community.

Over
the
past
two
years,
homeless
service
providers
in
Knoxville
have
worked

toegther
to
build
collaborative
programs
that
move
people
out
of
homelessness.
For

example,
the
Knoxville-‐Knox
County
Community
Action
Committee
has
led
the
charge
of

homelessness
prevention
through
offering
case
management
in
the
high
rises
of
KCDC

and
by
adminstering
the
homeless
prevention
and
rapid
rehousing
programs.
Knoxville

Leadership
Foundation
opened
Flenniken
Landing
in
South
Knoxville,
a
new
permanent

supportive
housing
facility
that
will
house
48
individuals.
Voluneer
Ministry
Center

provides
case
management
for
those
residents.

The
development
of
the
Knoxville
Homeless
Management
Information
System

(KnoxHMIS)
offers
a
means
of
greater
service
coordination
and
accountability.

Fifteen

agencies
are
participating
and
KnoxHMIS
continues
to
be
in
discussion
with
potential

partners
planning
to
join
the
system,
approximately
27,000
individuals
have
been

entered
into
the
database.
KnoxHMIS
is
an
important
management
tool
for
coordinated

case
management
as
well
as
monitoring
the
extent
of
homelessness.

This
report
incorporates
much
of
the
narrative
from
the
earlier
reports.
The

research
findings
from
2012
are
reported
and
compared
with
the
2010
data.
The

description
of
resources
has
been
updated.
Previous
introductory
material
on
definition,

causes,
and
patterns
is
still
quite
relevant,
with
a
few
additional
research
citations.

One

feature
initiated
in
the
2002
study
was
brief
case
examples
that
“put
a
face”
on

homelessness
and
this
is
continued
in
the
2012
study.
These
composites
were
submitted

by
agency
staff
and
do
not
violate
the
confidentiality
of
the
respondents
or
agency

clients.

Despite
the
experience
of
studying
homelessness
for
more
than
twenty-‐six
years,

a
number
of
variables
continue
to
impact
findings:

how
one
defines
homelessness,
the

transitional
nature
of
homelessness,
and
the
complexity
of
causes
of
homelessness.

Since
the
initial
research,
it
has
been
apparent
that
any
study
of
homelessness
poses
a

formidable
challenge
including
how
one
determines
methods
of
enumeration.

Likewise

identifying
contributing
factors
is
a
complex
task.

A
brief
examination
of
these
factors

illustrates
the
issues.

Homlessness in Knoxville and Knox County, Tennessee 2011-20102 x

INTERVIEWERS
Chris
Smith

Mark
Stevens

Sonya
Roberts

Amye
Lewis

Autumn
Lowry

Vanessa
Hensley

Mary
Lou
Hammer

Wright
Karlin

Starlandria
Starks

Amanda
Messer

Tess
Leffman

Brad
Jennings

Marybeth

Snyder

Kristina
Kirkland

Jenna
Dougherty

Barbara
Disney

Linda
Rust

Mike
Dunthorn

Issac
Merkle

Gabe
Cline

Brittany
Adams

Jan
Cagle

Laurel
Laewski

Jennifer
Smith

Jaime
Frimpong

Shannon
Hitchcock

Joyce
Shoudy

Erin
Lang

Judy
Blackstock

Bruce
Spangler

Eva
Krug

Misty
Goodwin

Carl
Williams

Roosevelt
Bethel

Steven
Stothard

Lindsay
Preskenis

Matt
Silvey

Phillip
Carrigan

Beatrice
Irwin

Kristy
Carter

Debbie
Taylor

Sissy
Flack

Stacia
West

Roger
M.
Nooe

Homelessness in Knoxville and Knox County, Tennessee 2011-2012 1
Section I

A. Defining Homelessness
B. A Review of Contributing Risk Factors

Defining
Homelessness

How
one
defines
homelessness
will
have
a
significant
impact
on
estimated
numbers

and
characteristics.

Most
studies
are
limited
to
counting
people
who
are
in
shelters
or
on

the
streets.
In
almost
every
city,
the
estimated
number
of
homeless
people
exceeds
the

availability
of
emergency
shelters
and
transitional
housing
(U.S.
Conference
of
Mayors,

2007,
National
Law
Center
on
Homelessness
and
Poverty,
1997
and
2004).
These
findings

along
with
other
available
studies
suggest
that
many
people
experiencing
homelessness

may
be
“couch
homeless”,
living
with
friends
or
relatives
in
temporary
arrangements

(Hoback
&
Anderson,
2006,
Wright,
Caspi,
Moffit,
&
Silva,
1998).
This
“Doubled-‐up

housing”
(temporary
residence
with
relatives
and
friends)
may
not
be
included
in
a

definition
and
subsequent
count.
Likewise,
persons
living
in
single
room
occupancy
hotels

(SROs)
and
in
substandard
housing,
extremely
vulnerable
to
homelessness,
are
generally

not
included.

The
Annual
Homeless
Assessment
Report
(AHAR)
study
(Khadduri
&

Culhane,
2010)
underscores
the
high
risk
of
homelessness
and
resulting
utilization
of

homeless
residential
services
for
persons
“doubled
up”
or
precariously
housed.
In

addition,
persons
temporarily
staying
with
friends
or
family
together
make
up
30.2%
of

those
accessing
homeless
residential
assistance
nationally.

The
term
“homeless”
itself
is
misleading
in
that
it
implies
that
the
lack
of
residence

is
both
the
problem
and
cause,
obscuring
the
broader
factors,
such
as
poverty,
lack
of

affordable
housing,
and
employment,
as
well
as
personal
disabilities.
The
most
widely

utilized
definition
that
has
emerged
is
found
in
the
Homeless
Emergency
Assistance
and

Rapid
Transition
to
Housing
Act
of
2009
(Public
Law
111-‐22).

The
act
defines

homelessness
as
including
persons,

...who
resided
in
a
shelter
or
place
not
meant
for
human
habitation
and
who

are
exiting
an
institution
where
he
or
she
temporarily
resided,
(2)
people

who
are
losing
their
housing
in
14
days
and
lack
support
networks
or

resources
to
obtain
housing,
(3)
people
who
have
moved
from
place
to
place

and
are
likely
to
continue
to
do
so
because
of
disability
or
other
barriers,
and

(4)
people
who
are
victims
of
domestic
violence
and
sexual
assault.

While
the
above
provides
a
working
definition,
the
reader
should
be
aware
that
no
single

definition
or
characteristic
describes
all
persons
experiencing
homelessness.

Numbers

Attempts
to
estimate
the
extent
of
homelessness
have
shown
wide
variation
over

time.
Studies
of
homelessness
are
further
complicated
by
problems
of
methodology.
The

1996
and
1998
Knoxville
studies
recognized

the
range
of
findings
and
noted
the

difficulties
in
enumeration:


The
U.
S.
Department
of
Housing
and
Urban
Development
estimated
that

192,000
were
homeless
(HUD,
1984),
in
contrast
housing
activists
argued
that

3.2
million
persons
were
homeless
(Holmes
&
Snyder,
1982).

Later,
1990

government
materials
relied
on
a
study
conducted
by
the
Urban
Institute
that

found
that
on
any
given
night
up
to
600,000
persons
were
homeless
(Burt
&

Cohen,
1989).

However,
activists
continued
to
argue
that
there
were
more

than
three
million
homeless
people
in
the
United
States
(Kozol,
1988).
In

1994,
The
Interagency
Council
on
the
Homeless
(ICH)
published
“Priority:

Home!
The
Federal
Plan
to
Break
the
Cycle
of
Homelessness.”

A
major

conclusion
of
the
ICH
was
that
the
homeless
population
was
not
a
static
one,

but
that
large
numbers
of
different
people
flow
through
shelters
over
time
(a

conclusion
that
had
been
emphasized
by
the
Knoxville
studies
in
1987
and

1988).
This
new
federal
position
emphasized
that
homelessness
had
been

previously
underestimated.

A
continuing
major
difficulty
in
examining
the
extent
of
homeless
lies
in
the
use
of

different
sources.
In
2009
for
example,
the
State
of
Homelessness
in
America
Report

indicated
that
as
many
as
656,000
people
are
homeless
on
any
given
night
and

approximately
3.5
million
people,
1.3
million
of
them
children,
experience
homelessness

each
year
(National
Alliance
to
End
Homelessness,
2011,
National
Law
Center
on

Homelessness
and
Poverty,
2007).
More
recent
studies
suggest
that
the
total
number
of

homeless
persons
increased
by
less
than
1%
between
2009
and
2010.
A
snapshot
of

homeless
persons
in
2010
found

that
over
649,000
were

homeless
on
a
given
night,
with

approximately
1.59
million
people
spending
at
least
one
night
in
a
shelter
between

October
2009
and
September
2010
(Annual
Homeless
Assessment
Report,
2010).

Projections
suggest
that
approximately
1%
of
the
U.S.
population
will
experience

homelessness
each
year
(Urban
Institute,
2000).
According
to
the
U.S.
Conference
of

Mayors
(2011)
survey,
hunger
and
homelessness
continue
to
rise
in
major
American
cities.

In
the
twenty-‐nine
cities
that
responded
to
the
survey,
the
number
of
families

experiencing
homelessness
increased
by
an
average
of
sixteen
percent
in
2010
(U.S.

Conference
of
Mayors,
2011).

The
methodology
to
use
in
counting
individuals
experiencing
homelessness
is
a

major
issue.

For
example
an
early
study
by
Link
(1994)
suggested
that
homelessness
was

two
to
three
times
more
extensive
than
early
estimates.
Using
a
household
sampling

method,
the
researchers
found
that
approximately
7.4
percent
of
all
adult
Americans
had

at
some
point
experienced
literal
homelessness.
An
interesting
aspect
of
the
report
was

recognition
of
the
difficulties
in
counting
the
homeless,
including:
(1)
finding
the
hidden

homeless,
i.e.,
those
who
sleep
in
boxcars,
on
roofs,
or
other
obscure
locations,
(2)

encountering
respondents
who
deny
homelessness
or
refuse
interviews
(Rossi,
1989),
and

(3)
not
including
people
who
experience
short
or
intermittent
episodes
(Link,
1994).
As

noted,
determining
the
extent
of
homelessness
is
difficult,
and
reliable
studies
are
scarce.

The
National
Census
in
1990
and
2000
included
a
concentrated
effort
to
identify
those

persons
who
were
homeless,
however,
counting
difficulties
continued
to
hamper
this

effort.
The
1990
effort
included
S-‐night
(referring
to
counting
street
and
shelter
residents)

along
with
experiments
using
“homeless
decoys”
in
five
major
cities.
A
significant
number,

over
one-‐half
were
missed,
demonstrating
the
difficulty
in
counting
the
people

experiencing
homelessness
(Wright
&
Devine,
Straw,
1995).
The
2010
census
used
a

service-‐based
enumeration
(SBE)
that
focused
on
persons
who
were
homeless.

The

recommendation
following
the
2000
“dress
rehearsal”
detailed
that
SBE
appears
to
be
a

successful
method
of
including
people
who
otherwise
would
not
be
counted.

Another
consideration
in
counting
the
homeless
is
whether
the
count
is
a
point-‐
prevalence
or
period-‐prevalence
estimate.
Point-‐prevalence
estimates
are
made
at
a
given

time,
but
do
not
account
for
turnover
or
variability
over
time.
On
the
other
hand,
the

counts
reflect
the
size
of
the
population
for
a
specified
period
of
time.

Consequently,
counts
typically
exceed
point-‐prevalence
counts
(Quigley

&
Raphael,
2001).
The
Homeless
Management
Information
System
(KnoxHMIS)
that
was

initiated
in
2004
increases
accuracy
in
counting
the
homeless
as
well
as
charting

variations.

In
sum,
reports
have
been
consistent
in
recognizing
that
the
homeless
population
is

not
static.
The
Knoxville
studies
have
consistently
asserted
that
the
homeless
population
is

dynamic
and
that
numbers
must
be
explained
within
a
designated
time
frame.
Different

patterns
of
homelessness–situational,
episodic,
and
chronic–will
determine
who
is

homeless
at
a
given
time.

Situational
homelessness
is
usually
acute,
a
home
burns,
the
wage
earner
is

laid
off,
a
family
is
evicted
or
family
abuse
causes
unexpected
homelessness.

Episodic
homelessness
is
recurring,
a
person
works
seasonally
and
has

lodging,
disability
benefits
are
sufficient
for
a
room
(SRO)
several
weeks
a

month,
or
the
person
has
a
home
with
family
when
not
drinking.
This
group

includes
the
"couch
population"
who
usually
stays
with
relatives
or
friends

but
have
meals
at
shelters.
Chronic
homelessness
is
ongoing,
the
person

remains
on
the
street
indefinitely,
some
may
be
alcoholic
or
severely
mentally

ill
(Nooe
&
Cunningham,
1990).

These
different
patterns
offer
explanation
for
differences
in
enumeration
and
also

public
perceptions
of
homelessness.
While
the
chronic
homeless
are
usually
the
most

visible,
they
likely
represent
the
smallest
segment
of
the
homeless
population.
The

category
of
situational
homelessness
is
the
largest
when
measured
over
time.
The
fact
that

the
chronic
segment
is
most
costly
in
terms
of
use
of
public
services
is
a
key
rationale
in

cities
developing
a
Ten
Year
Plan
to
End
Chronic
Homelessness.

Review
of
Contributing
Risk
Factors

The
homeless
population
continues
to
be
one
of
the
fastest
growing
sub-‐
populations,
despite
the
United
States
having
periods
of
significant
economic
growth.
The

impact
of
the
economic
crisis
being
experienced
by
the
United
States
since
2008
is

continuing
to
be
examined.
According
to
the
U.S.
Conference
of
Mayors
(2011),
twelve

of

twenty-‐nine
cities
surveyed
reported
an
increase
in
homelessness,
and
seventeen

reported
adopting
new
policies
as
a
result
of
the
recent
increase
in
need
following
the

housing
crisis.

The
National
Coalition
for
the
Homeless
asserts
that
two
trends
are
primarily

responsible
for
the
increase
in
homelessness
during
the
past
twenty-‐five
years:
a
growing

shortage
of
affordable
housing
and
a
simultaneous
increase
in
poverty
(NCH,
2007).
In
a

sense,
homelessness
represents
the
“poorest
of
poor”.
In
2010,
people
below
the
official

poverty
thresholds
numbered
46.2
million,
a
figure
2.6
million
higher
than
the
2009

estimate
(U.S.
Conference
of
Mayors,
2011).

Related
to
the
problems
of
poverty
is
the
decline
in
public
assistance.
The
Knoxville

studies
have
included
questions
about
sources
of
assistance
and
also
loss
of
benefits.
The

National
Coalition
for
the
Homeless
offered
this
finding:

The
declining
value
and
availability
of
public
assistance
is
another
source
of

increasing
poverty
and
homelessness.
Until
its
repeal
in
August
1996,
the
largest

cash
assistance
program
for
poor
families
with
children
was
the
Aid
to
Families

with
Dependent
Children
(AFDC)
program.
The
Personal
Responsibility
and
Work

Opportunity
Reconciliation
Act
of
1996
(the
federal
welfare
reform
law)
repealed

the
AFDC
program
and
replaced
it
with
a
block
grant
program
called
Temporary

Assistance
to
Needy
Families
(TANF).
In
2005,
TANF
helped
a
third
of
the
children

that
AFDC
helped
reach
above
the
50%
poverty
line.
Unfortunately,
TANF
has
not

been
able
to
keep
up
with
inflation.
The
Center
on
Law
and
Social
Policy
states
a

27%
decrease
in
the
TANF
block
grant
due
to
recent
inflation.
Given
this
drastic

decrease
in
available
funding,
low-‐income
families
are
not
able
to
receive
sufficient

assistance
from
the
very
program
that
was
conceived
to
help
them
(Carey,
2010).

Between
2006
and
2008,
TANF
case
load
has
continued
to
decline
while
food
stamp

caseloads
have
increased.
(NCH,
2009).

These
changes
in
public
attitudes
and
policy
have
major
implications,
although
the

effects
have
not
been
fully
assessed.
The
United
States
has
witnessed
the
most
dramatic

shift
in
welfare
policy
since
its
inception
in
1935
(Berger
&
Tremblay,
1999).
Changing

public
attitudes
are
producing
revisions
that
result
in
stricter
guidelines
for
subsidies
and

services
(Dunlap
&
Fogel,
1998).
Resources
such
as
AFDC
have
been
important
in

preventing
homelessness,
and
more
exclusionary
guidelines
will
likely
increase

vulnerability
to
homelessness
(Institute
for
Children
and
Poverty,
2001,
Butler,
1997).

While
the
foregoing
and
other
studies
present
a
case
for
structural
or
external

factors,
such
as
lack
of
housing,
income
and
employment
opportunities
(McChesney,
1991,

Trimmer,
Eitzen,
&
Talley
1994,
Quigley
&
Raphael,
2001),
there
is
considerable
evidence

that
homelessness
is
also
due
to
personal
problems
or
internal
factors
such
as
mental

illness,
substance
abuse,
and
personality
deficits
(U.S.
Conference
of
Mayors,
2005,
Bassuk,

Rubin
&
Lauriat,
1984,
Lamb
&
Lamb,
1990,
Baum
&
Barnes,
1993,
Jenks,
1994,
Federal

Task
Force
on
Homelessness
and
Severe
Mental
Illness,
1992).
Most
likely,
homelessness

is
due
to
multiple
interacting
factors.
These
contributing
factors
may
vary
for
segments
of

the
homeless
population,
for
example,
differences
exist
in
rural
and
urban
homelessness,

not
only
in
the
environment
but
also
in
coping
strategies
(Goodfellow,
1999,
Cummins,

First,
&
Toomey,
1998,
Nooe
&
Cunningham,
1992).
Perhaps
Burt
(1992)
sums
up
the

complexity
of
factors
most
accurately:

“...poverty
represents
a
vulnerability,
a
lower
likelihood
of
being
able
to

cope
when
the
pressure
gets
too
great.
It
thus
resembles
serious
mental

illness,
physical
handicap,
chemical
dependency,
or
any
other
vulnerability

that
reduces
one’s
resilience...”

While
recognizing
that
the
reasons
behind
homelessness
are
complex,
and
multiple
factors

are
usually
interacting,
it
is
helpful
to
examine
risk
factors
such
as:

(1)
lack
of
affordable

housing,
(2)
mental
illness
and
deinstitutionalization,
(3)
labor
market
changes,
(4)

substance
abuse,
(5)
lack
of
education,
(6)
personal
crises
[abuse,
divorce,
death]
and
(7)

personal
risk
factors.

Housing

The
increasing
shortage
of
affordable
housing
and
the
decrease
of
available
public

assistance
due
to
federal
budget
cuts
are
major
contributors
to
homelessness.
Many
families

are
now
paying
more
than
fifty
percent
of
their
annual
income
in
order
to
maintain

permanent
housing.
With
housing
costs
at
an
unprecedented
high,
many
homeowners
and

renters
are
finding
it
difficult
to
provide
for
other
basic
needs
such
as
healthcare
and

nutrition
(HUD
2011).
Roughly
seventy
percent
of
families
with
who
experience
difficulty

affording
housing
have
an
income
below
thirty
percent
of
the
states
median
income,
which

is
approximately
equivalent
to
the
poverty
threshold

,
2007).
Approximately
150,000
Section
8
vouchers
were
lost
between
2005
and

2007,
due
to

federal
budget
cuts
and
the
increasing
pressure
to
reduce
domestic
spending

(Rice
&
Sard,
2007).

In
addition,
Rice
&
Sard
(2007)
explain
that
over
170,000
low
rent

units
were
lost
over
the
past
decade
due
to
demolition,
decay
or
abandonment,
thus

resulting
in
fewer
housing
options
for
low-‐income
families.
The
Joint
Center
for
Housing

Studies
(2011)
estimated
a
gap
between
affordable
units
and
low-‐income
renters
of
more

than
6.4
million
units
in
2009.
The
significant
reduction
in
private
sector
low-‐income

housing
is
often
overlooked
in
the
clamor
for
more
public
housing.

The
loss
of
single
room
occupancy
housing
(SRO)
has
been
particularly
devastating.

Dolbeare
(1996)
estimates
that
more
than
one
million
units
were
lost
in
the
1970's
and

80's.

Many
Knoxville
citizens
can
remember
private
sector
hotels
and
rooming
houses
that

provided
cheap
lodging,
but
many
of
these
have

been
razed
or
converted
to
condominiums

in
the
apparent
gentrification
of
the
inner
city.
It
may
be
that
the
new
SROs
are
the

increasing
number
of
suburban
motels,
offering
low
rates
and
catering
to
a
transient

population.
The
availability
of
various
types
of
housing
that
includes
SROs,
as
well
as

subsidized
supervised
housing
and
private
housing
is
a
critical
factor
in
preventing

recurrent
homelessness
(Wong,
Culhane,
&
Kuhn,
1997).

As
noted,
an
interesting
phenomenon
in
recent
years
has
been
the
transformation
of

motels
into
SROs,
and
the
expansion
of
these
into
locations
outside
the
central
city.
This
is

evidenced
in
a
variety
of
motels
in
the
Knoxville
and
Knox
County
Metropolitan
area
that

have
become
SROs
over
the
past
six
years.
The
conversion
of
the
motels
from
tourist-‐based

facilities
to
serving
low
income
and
working
poor
families
is
resulting
in
a
new

distributional
pattern
of
homelessness
throughout
Knox
County.
Another
aspect
of
housing

mentioned
earlier
is
the
practice
of
“doubling-‐up”.

Staying
with
friends
or
relatives

commonly
precedes
homelessness
(Hoback
&
Anderson,
2006,
Wright,
Caspi,
Moffit,
&
Silva,

1998).
This
practice
results
in
what
has
been
called
the
“couch
population”,
and
while

“doubling
up”
represents
a
type
of
housing,
the
risk
for
homelessness
is
very
high.
The

challenge
is
to
reduce
this
risk
through
stable,
permanent
housing.
The
following
vignette

describes
some
of
these
challenges:

Amy
and
her
son
lived
at
the
Broadway
building
that
was
condemned.
They

had
only
been
in
the
building
a
few
months
prior
to
the
demolition.
Amy
was

recently
divorced
and
previously
lived
somewhere
that
was
not
energy

efficient
and
incurred
unaffordable
utility
bills.
Amy
was
unable
to
pay
the

utilities
and
thus
had
to
move.
The
rental
on
Broadway
included
utilities

with
the
rent.
In
order
to
afford
her
rent,

Amy
worked
as
a
low
paid

manager
of
a
bakery
in
town.
She
could
pay
her
rent
but
was
never
able
to

catch
up
on
the
utilities
and
afford
the
$200
deposit
and
$20
connection
fee

KUB
would
require
before
she
could
move
into
a
decent
place.
With
the
help

of
a
case
manager,
Amy
was
able
to
temporarily
move
with
her
son
to
a

friend’s
house.
The
friend
lived
far
north
so
this
case
manager
provided
bus

tickets
for
both
Amy
and
her
son
to
go
to
school
and
work.
The
case

manager
helped
the
family
search
for
affordable
housing.
The
original

eviction
was
a
barrier
but
advocacy
on
the
part
of
the
case
manager

convinced
the
apartment
complex
to
take
a
chance
on
Amy.
With
funds
from

the
city,
Amy
was
able
to
pay
off
the
utility
bill,
obtain
a
section
8
voucher,

and
pay
the
housing
application
and
deposit
so
that
the
she
could
go
into

decent
affordable
housing.
The
client
and
her
son
remain
in
that
housing
at

this
time
and
are
stable.

Finding
permanent
housing
may
be
complicated
by
poor
payment
history,
prior

criminal
offenses
and
substance
abuse.
There
is
also
the
need
for
supportive
housing
for

those
with
disabilities
including
mental
illness
and
addictive
disorders.
As
the
National

Coalition
for
the
Homeless
(2005)
points
out,
during
the
last
two
decades,
competition
for

increasingly
scarce
low-‐income
housing
has
been
particularly
traumatic
for
those
with

addictive
and
mental
disorders,
often
increasing
the
risk
for
them
becoming
homeless.

In
some
respects,
Knoxville
has
more
housing
resources
than
other
metropolitan

areas.
The
combination
of
public
housing,
private
facilities
and
emergency
shelters
results

in
less
than
twenty-‐five
percent
of
the
homeless
living
in
outside
locations
and
this
is

often
by
choice.
Some
cities
report
that
the
greatest
numbers
of
homeless
are
living
in

outside
locations,
and
in
the
National
Survey
of
Homeless
Assistance
Providers
and

Clients
(NSHAPC)
study,
thirty-‐one
percent
reported
sleeping
on
the
streets
or
in
other

places
not
meant
for
human
habitation
(U.S.
Conference
of
Mayors,
2007,
ICH,
1999).
The

Ten
Year
Plan
called
for
a
“housing
first”
approach
that
combines
affordable,
permanent

housing
with
the
supportive
services
necessary
for
the
individual
to
remain
in
permanent

housing.
The
need
for
comprehensive
supportive
services
to
maintain
persons
in
housing

is
underscored
by
the
Knoxville
studies’
consistent
findings
that
many
persons
placed

into
housing
without
support
services
simply
recycle
back
into
homelessness
(Ten
Year

Plan,
2005,
Homelessness
in
Knoxville-‐Knox
County,
2004).

Current
Economic
Crisis

Currently,
the
United
States
is
enduring
a
substantial
economic
crisis
that
began

with
the
failing
and
subsequent
bailouts
of
numerous
national
financial
institutions.
The

recession
of
2008
is
still
affecting
citizens
in
terms
of
employment,
access
to
social

services,
and
the
ability
to
obtain
housing.
People
experiencing
homelessness
or
extreme

poverty
are
especially
at
risk
during
times
of
national
economic
strain
(Olivet
et
al.,
2010).

Specifically,
the
number
of
people
experiencing
homelessness
increased
between
2008

and
2009
by
20,000
following
the
first
year
of
economic
crisis
(National
Alliance
to
End

Homelessness,
2011).

Prior
to
the
recession
of
2008,
the
unemployment
rate
in
the
United
States
was

5%,
as
of
February
2012
it
was
8.3%,
with
a
peak
unemployment
rate
of
10%
in
October

of
2010
(Bureau
of
Labor
and
Statistics,
2012).
With
the
unemployment
rate
hovering
at

an
unprecedented
high,
more
people
have
been
left
without
the
ability
to
afford
housing,

health
insurance,
and
other
basic
needs
necessary
for
survival.
People
experiencing

homelessness
are
especially
affected
by
the
declining
number
of
available
jobs.

In
addition,
the
United
States
government
has
implemented
federal
budget
cuts
to

social
service
funding.
In
2012,
the
Department
of
Health
and
Human
Services
incurred

the
second
largest
proposed
budget
cut
of
the
year,
a
loss
of
$876
million.
Among
the

Department
of
Health
and
Human
Services
programs
that
have
been
cut
is
the

Homelessness
Prevention
and
Rapid
Re-‐Housing
Program
(HPRP).
HPRP,
a
three
year,
1.5

billion
dollar
program,
was
able
to
serve
over
700,000
individuals
and
families
during
its

first
year,
however,
the
time
allotted
has
run
out
and
the
program
no
longer
exists
to
aid

individuals
and
families
in
need
of
emergency
housing
(Khadduri
&
Culhane,
2010).
As
a

result,
programs
that
assist
those
who
are
homeless
or
at
risk
of
becoming
homeless
are

either
losing
federal
funding
or
ceasing
to
exist
altogether.

The
national
housing
market
has
also
been
detrimentally
affected
by
the
economic

crisis
evidenced
by
a
significant
reduction
affordable
housing
units
(Wardrip,
et.
al,

2009).
Individuals
and
families
already
experiencing
difficulty
obtaining
permanent

housing,
such
as
those
in
extreme
poverty
or
low-‐income
families,
are
now
finding
it
even

more
difficult.
The
economic
crisis
has
caused
more
than
2
million
home
foreclosures
in

2007
alone
(NCH,
2008).
According
to
the
National
Coalition
for
Homelessness
(2008),

there
is
a
direct
correlation
between
the
economic
crisis
and
the
increase
in
national

homelessness
as
more
families
are
losing
their
homes.

Mental
Illness
&
Deinstitutionalization

The
role
of
mental
illness
and
deinstitutionalization
in
homelessness
has
been

debated.
Lee
et
al.,
(2003)
argue
that
is
a
major
contributing
factor,

whereas
the
National
Coalition
for
the
Homeless
(1997)
initially
asserted
that

had
little
impact
on
the
number
of
homelessness
but
more
recently

identified
it
as
a
contributing
factor
(NCH,
2008).
The
Knoxville
studies,
as
well
as
a

number
of
national
studies,
present
strong
evidence
that
mental
illness
and

are
significant
contributing
factors.

The
estimated
rates
of
mental
illness
among
the
homeless
are
wide-‐ranging

depending
on
methodology,
definitions,
sample
selection
and
diagnostic
criteria.
For

example,
shelter
users
tend
to
have
higher
rates
of
mental
illness
than
do
non-‐sheltered

homeless
persons.
The
2010
AHAR
indicated
that
roughly
thirty-‐seven
percent
of
shelter

residents
had
a
disability,
although
it
did
not
specify
the
conditions.
The
Knoxville

studies
have
consistently
found
that
approximately
50%
of
the
homeless
individuals

surveyed
had
been
treated
for
emotional
problems.
However,
these
estimates
are
likely

conservative,
given
the
incidence
of
untreated
individuals
and
those
who
are
in
jails,

prisons,
or
otherwise
unidentified
(AHAR,
2007,
Toro,
Bellavia,
Daeschler,
Owens,
Wall,

&
Passero,
1995,
Lamb
&
Weinberger,
1998,
Susser,
Lin,
Conover,
&
Struening,
1997).

The
incidence
of
mental
illness
is
complicated
by
the
number
of
mentally
ill
persons
who

abuse
substances,
i.e.,
the
dually
diagnosed.
Persons
who
have
a
severe
mental
illness

(e.g.,
schizophrenia
or
bipolar
disorder)
and
drug
dependencies
are
five
times
more

likely
to
become
homeless
(Shelton
et
al.,
2009).
Studies
have
found
that
approximately

thirty
percent
of
persons
discharged
from
state
psychiatric
institutions
will
be
homeless

within
six
months
(Belcher
&
Toomey,
1988).
For
persons
with
mental
illness,

homelessness
has
a
detrimental
effect
and
like
any
other
crisis
or
trauma,
may
“catalyze

and/or
exacerbate
mental
illness
producing
disorder
where
previously
it
did
not
exist”

(NCEH,
2000,
Koegel
&
Burnam,
1992,
p.
96).

Scott
is
a
Knoxville
native
in
his
mid-‐twenties.
Raised
in
a
middle
class
home,
he

had
a
good
education
and
private
medical
insurance.
When
he
became
ill
with

schizophrenia
in
his
late
teens,
Scott’s
parents
were
able
to
get
him
into

treatment.

However,
once
he
became
an
adult,
he
was
free
to
make
his
own
choices

about
continuing
on
medication.
Sadly,
one
symptom
of
his
illness
was
to
believe

that
the
voices
he
heard
were
direct
messages
from
God.
Soon,
the
arguments

between
Scott
and
his
parents,
as
well
as
the
physical
destruction
he
caused
when

fighting
“demons,”
made
it
impossible
for
him
to
continue
to
live
at
home.
After

several
years
on
the
street,
Scott
connected
with
a
case
manager.
Scott
engaged

with
a
mental
health
provider
and
was
able
to
obtain
housing.
Unfortunately,
even

with
supportive
services,
Scott
continued
to
refuse
medication
as
part
of
his

treatment
plan.
After
over
a
year
of
outbursts
in
his
apartment,
he
had
to
leave
due

to
disturbing
his
neighbors
and
damaging
the
property.

Because
there
were
no

services
that
could
meet
his
needs,
Scott
returned
to
the
streets.

Homelessness
and
mental
illness
have
become
intertwined
with
the
criminal

justice
system.
There
is
mounting
evidence
of
an
increasing
number
of
severely
mentally

ill
persons
in
jails
and
prisons
(Greenberg
&
Rosenheck,
2006,
Lamb
&
Weinberger,

1998).
People
experiencing
homelessness
have
become
criminalized,
and
in
a
sense,
jails

are
becoming
today's
asylums
(The
Bazelon
Center
for
Mental
Health
Law,
2008).

The

interaction
of
these
factors
is
seen
in
the
finding
that
non-‐homeless
mentally
ill
persons

going
into
jail
have
a
significantly
increased
risk
of
housing
loss
(NCH,
2008,
Solomon
&

Draine,
1995).
The
cost
of
this
recycling
from
homelessness
to
incarceration
and
back
is

costly,
and
supportive
housing
treatment
programs
provide
a
feasible
alternative

(Rosenheck,
et
al.,
2003).

Dominic is a 38-year-old man who was recently released from prison. Prior to
incarceration, he lived in Knoxville. While serving a 14-year sentence for a violent
offense Dominic was diagnosed with paranoid schizophrenia and started taking

medication. Dominic came to the day shelter 3 days after his release, noting that he
didn’t have any of his antipsychotic medications, did not have a doctor, and did not
know where to go for help. Luckily, several agencies were able to coordinate and he
was soon seen by a medical professional who was able to get him back on his
medication. Dominic worked on a case plan of following up with mental health care,
completing an anger management class and starting an application for disability
benefits. Dominic applied for housing, but unfortunately was denied. When he went to
his appeal, he was told to return in 6 months with no new charges. Dominic has
managed to stay on track and is now ready to reapply with the landlord. He is hopeful
that he will soon be off the streets and in his own apartment.

Employment

Lack
of
employment
is
often
identified
as
a
major
cause
of
homelessness,

however,
many
people
experiencing
homelessness
report
being
employed
or
having

occasional
work.
The
difficulty
is
that
many
of
these
jobs
do
not
provide
adequate
wages

and
benefits
for
self-‐sufficiency.
The
current
value
of
the
minimum
wage
has
not
kept
up

with
economic
growth
and
this
is
particularly
detrimental
in
the
midst
of
the
economic

crisis.
The
growing
disparity
between
the
rich
and
poor
is
particularly
straining
to
low-‐
wage
earners
due
to
the
insufficient
real
value
of
the
federal
minimum
wage
that
has
not

kept
pace
with
inflation.
In
2010,
the
federal
minimum
wage
was
$7.25
per
hour,
as

opposed
to
the
1968
minimum
at
$8.50
per
hour,
in
2010
dollars
(Economic
Policy

Institute,
2011).

The
ICH
found
that
the
median
monthly
income
for
persons
who
were

homeless
was
about
44%
of
the
federal
poverty
level
(1999).
While
the
value
of
the

minimum
wage
has
not
kept
up
with
inflation,
there
has
also
been
a
decline
in

manufacturing
jobs
and
a
corresponding
increase
in
low
paying
service
employment,

globalization,
decline
in
union
bargaining
power,
and
increase
in
temporary
work,
that

are
factors
in
wage
decline
(USICH,
1999).

Many
of
the
jobs
held
by
homeless
persons
are
temporary
or
do
not
provide

sufficient
wages
to
provide
self-‐sufficiency.
The
ICH
(1999)
recognized
that
employment

prospects
are
dim
for
those
who
lack
appropriate
skills
or
adequate
schooling.
The
labor

market
has
changed,
as
evidenced
by
"plant
relocations
and
closures,
persistent
racial

discrimination,
changes
in
industry
that
have
increased
the
demand
for
highly
educated

people,
the
decline
in
the
real
value
of
the
minimum
wage,
and
the
globalization
of
the

economy"
(ICH
p.
27).
Employment
instability
and
the
lack
of
employment
benefits
have

both
been
identified
in
several
studies
as
a
risk
factor
for
homelessness
(NCH,
2009,

Wagner,
1994).
Women
and
minorities
seem
to
experience
fewer
employment

opportunities
(Anti-‐Discrimination
Center
of
Metro
New
York,
2005,
ACLU,
2004,
Butler,

1995).

The
Ten
Year
Plan
to
End
Chronic
Homelessness
calls
for
increased
economic

opportunities
for
homeless
persons.
Achieving
maximum
economic
self-‐sufficiency
will

involve
developing
appropriate
training
programs,
supportive
employment,
and

establishing
income
management
and
financial
guardianship
programs
where
applicable.

Substance
Abuse

Habitual
heavy
substance
abuse
is
a
major
contributor
to
homelessness

(Tam,

Zlotnick
&
Robertson,
2003,
Marqura,
2000).
Instances
of
drug
and
alcohol
abuse
are

disproportionately
high
among
the
population
of
persons
experiencing
homelessness

(NCH,
2009).
However,
the
relationship
between
homelessness
and
substance
abuse
may

be
more
complex
than
it
first
appears.

For
example,
those
who
are
addicted
may
be
more

impacted
by
the
decrease
in
availability
of
SROs
(NCH,
2007).
Likewise,
the
lack
of
access

to
affordable
health
insurance
may
be
a
barrier
in
dealing
with
addiction.
Policy
changes

in
1996
reducing
eligibility
for
Social
Security
Income
(SSI)
based
on
chronic
substance

abuse
likely
increased
the
risk
for
loss
of
housing
and
homelessness
(National
Health
Care

for
the
Homeless
Council,
2005).
Similarly,
policy
changes
that
result
in
persons
convicted

of
drug
abuse
or
sales
being
barred
from
public
housing
have
created
additional

dilemmas.
Use
of
drugs
other
than
alcohol
has
increased
dramatically
among
the

homeless.

Single
homeless
men
are
especially
likely
to
have
histories
of
substance
abuse

(Toro,
Bellavia,
Daeschler,
Owens,
Wall
&
Passero,
1995).
In
any
case,
substance
abuse
is

a
major
factor
as
illustrated
by
a

study
estimating
that
roughly
60%
of
homeless
men

experience
long-‐term
alcoholism
(Hwang,
2001).
Substance
abuse
disorders
are
also

prevalent
among
homeless
women
(Bassuk,
Buckner,
Perloff
&
Bassuk,
1998).

Many
individuals
are
dually
diagnosed,
suffering
from
both
a
major
mental
illness

and
substance
abuse
(Hartwell,
2003,
Task
Force,
1992,
Barber,
1994).
These
dually

diagnosed
individuals
frequently
fall
between
the
cracks
because
neither
mental
health

nor
substance
abuse
treatment
facilities
provide
comprehensive
services.
Substance

abuse
contributes
to
the
lack
of
funds
for
housing
and
also
may
increase
family
conflict,

leading
to
family
unwillingness
to
allow
individuals
to
remain
in
the
home.

After
Rachel’s
house
caught
fire,
she
and
her
7-‐year-‐old
daughter
had

nowhere
to
go.
They
continued
to
live
in
the
burnt,
condemned
house
as

long
as
they
could
because
it
was
their
only
option.
Finally
Rachel
and
her

daughter
left
the
house
and
began
living
in
their
car.
Living
in
these

conditions
had
a
severe
effect
on
her
daughter’s
health
and
performance
in

school.
Her
school
social
worker
became
involved
and
referred
Rachel
to
a

permanent
supportive
housing
program
for
women
and
their
children.
After

receiving
short-‐term
assistance
from
an
emergency
shelter,
Rachel
was

accepted
into
the
permanent
supportive
housing
program.
Sadly,
just
before

Rachel
was
able
to
move
in,
DCS
removed
her
daughter
from
her
custody

due
her
previous
inability
to
provide
a
safe,
stable
home
for
her
daughter.

Rachel
moved
into
a
fully-‐furnished
apartment
and
was
assigned
an

advocate
to
help
her
adjust
to
her
new
housing
and
independence.
Rachel

has
a
mental
health
diagnosis
of
PTSD
and
depression,
and
her
advocate

worked
with
her
and
connected
her
with
resources
to
ensure
that
her

mental
health
was
stabilized
and
her
medications
managed
correctly
so
that

she
could
move
forward
with
her
mental
health
recovery.
Rachel
also
had
a

past
history
of
substance
abuse,
but
was
not
receiving
any
treatment
or

support
for
her
addiction
when
she
entered
the
program.
Her
advocate
was

able
to
connect
her
with
community
resources
for
substance
abuse,
and

Rachel
now
attends
a
recovery
program
on
a
regular
basis
and
is
addressing

her
addiction.
Rachel
is
working
with
her
advocate
to
apply
for
SSI
benefits

so
that
she
can
have
a
stable
income.
Most
importantly,
Rachel
has
been

working
with
her
advocate
on
her
goal
of
regaining
custody
of
her
daughter.

She
has
been
working
diligently
with
DCS,
and
she
now
has
regular
visits

with
her
daughter.
Rachel
looks
forward
to
getting
overnight
visits
with
her

daughter
soon,
and
ultimately
regaining
custody
of
her
daughter
so
that

their
family
will
be
whole
again.

Education

Inadequate
education
has
not
been
clearly
identified
as
a
causative
factor
in

studies
focused
on
homelessness.
However,
the
National
Law
Center
on
Homelessness

and
Poverty
states
that
less
than
38%
of
the
homeless
population
has
obtained
a
high

school
degree
by
the
age
of
eighteen
(2010).
In
the
Knoxville
studies,
more
than
fifty

percent
of
the
respondents
reported
having
graduated
from
high
school,
with
a

significant
percent
having
post-‐high
school
education.
However,
given
the
increased

requirement
for
technical
and
educational
competence
to
be
self-‐sufficient,
it
is
logical
to

assume
that
poor
education
is
a
contributing
factor
to
homelessness.

David
grew
up
in
the
foster
care
system.
As
a
child,
David
was
angry
and
proved

problematic
for
both
his
foster
parents
and
DCS
workers.

He
dropped
out
of
school

and
also
got
his
girlfriend
pregnant
as
a
teenager.
Not
long
after
dropping
out
of

school,
David
noticed
his
younger
brother
doing
the
same
things
and
realized
he

could
not
help
his
brother
unless
he
first
helped
himself.
David
decided
to
enter
an

independent
living
program
sponsored
by
Department
of
Children
Services.

Though
the
program
was
able
to
aid
David
in
getting
his
GED,
unfortunately
they

were
unable
to
secure
independent
housing.
When
David
turned
eighteen,
he

became
homeless.
He
began
to
move
around,
staying
with
friends
and
his
biological

family
who
were
not
stable
and
ended
up
homeless
themselves.
At
the
age
of

nineteen,
David
found
himself
living
at
a
local
social
services
agency.
Eventually,

David
was
able
to
find
himself
a
full-‐time
job
and
bought
an
old
car
for

transportation.

He
tested
for
the
LPN
program
through
a
technical
school

and
was

accepted
into
the
program,
but
will
have
to
wait
almost
a
year
to
start
classes
due

to
a
waiting
list.
While
waiting,
David
remained
homeless
until
being
referred
to
a

local
program
that
helps
people
experiencing
homelessness
obtain
housing.
A
case

manager
with
the
program
was
able
to
assist
him
in
finding
an
apartment
he
could

afford
and
helped
him
with
his
rental
deposit.

David
now
knows
where
he
is
going

to
sleep
every
night,
continues
to
work,
is
excited
about
starting
LPN
classes
in
the

fall
and
feels
confident
about
his
future.

One
reason
that
studies
may
fail
to
identify
educational
level
as
a
contributing

factor
is
illustrated
in
an
evaluation
of
an
employment
program.
In
comparing
those
who

were
successful
in
gaining
employment
and
housing
versus
those
who
were

unsuccessful,
the
educational
levels
of
the
groups
were
similar.
However
an
examination

of
proficiency
levels
in
reading
and
math
found
substantial
differences
between
the

successful
and
unsuccessful
groups
(Nooe,
1994).

Personal
Crises

Personal
crises
involve
various
stressful
situations
such
as
abuse,
family
conflict,

loss
of
a
job
or
housing,
and
loss
of
significant
others.
Crook
(1999)
notes,
“Women
are

particularly
vulnerable
to
the
precipice
of
homelessness
because
of
four
major
factors:
1)

family
dissolution,
2)
family
violence,
3)
lack
of
affordable
housing,
and
4)
low
wage

status”
(p.
52).
Many
homeless
women
are
survivors
of
abuse,
and
while
leaving
the

home
may
represent
a
solution
to
one
problem,
lack
of
employment
and
affordable

housing
frequently
results
in
homelessness
(Civil
Liberties
Union,
2004).
A
recent
study

shows
that
one
in
four
women
will
experience
domestic
abuse
within
their
lifetime
and

39%
of
cities
name
domestic
abuse
as
the
leading
cause
for
female
homelessness
(NCH,

2009).
In
addition,
women
who
have
experienced
violence
may
encounter

discrimination
from
landlords
who
are
relunctant
to
rent
to
them
(ACLU,
2004).

Likewise,
approximately
half
of
the
cities
surveyed
by
the
U.S.
Conference
of
Mayors

identified
abuse
as
a
major
cause
of
homelessness
(2005).

Cindy
is
a
Veteran
of
the
U.S.
Army
and
a
full-‐time
student
at
a
Knoxville

area
college.
This
summer,
her
abusive
boyfriend
almost
killed
her
and

her
eight-‐year-‐old
son
by
recklessly
driving
into
on-‐coming
traffic.
She

called
a
local
domestic
violence
shelter
several

days
later
when

he
was
at

work
and
brought
herself
and
her
son
to
shelter.
Through
the
safety

provided,
she
is
able
to
live
in
a
secured,
undisclosed
location
safe
from

him.
She
has
been
granted
a
preliminary
order
of
protection
and

continues
going
to
school,
where
she
has
a
4.0
GPA.
Her
son
continues
to

attend
his
regular
school
as
made
possible
by
the

county’s
school

homeless
programs,
and
he
is
shuttled
everyday
to
the
same
school
he

attended
last
year,
increasing
his
stability
and
continuity.
She
attends

weekly
support
groups
and
often
meets
with
a

therapist
to
discuss
the

abuse
she
has
suffered.
Through
these
meetings
she
says
she
has
learned

about
warning
signs
of
abusive
personalities
and
can
avoid
partners
such

as
this
in
the
future.
Her
son
attends
a

children’s
group
that

focuses
on

non-‐violent
conflict
resolution
in
an

effort
to
break
the
cycle
of
violence

from
generation
to
generation.
They
attend
parenting
classes
to
learn

non-‐violent
forms
of
discipline
and
to
foster
a
positive,
nurturing

relationship
together.
Through
referrals
to
community
agencies,
she
will

be
receiving
a
VASH
Voucher
for
assistance
with
public
housing
and
will

move
into
a
new
apartment
in
November.

The
assistance
Cindy
has

received
has
allowed
her
to
continue
with
her
education
and
will
allow

her
to
move
on
with
her
life
as
a
productive
member
of
society
while
she

and
her
son
live
free
from
violence
and
abuse.

In
2011,
the
U.S.
Conference
of
Mayors
reported
that
food
and
housing
insecurity

rates
for
families
headed
by
single
women
were
disproportionately
higher
than
the

national
average.
A
number
of
studies
have
found
that
female-‐headed
households
have

greater
risks
for
poverty
(National
Center
for
Law
and
Economic
Justice,
2011,
U.S.

Department
of
Commerce,
1998)
and
subsequently
have
greater
risks
of
homelessness

(Caton,
Shrout,
Boanerges,
Eagle,
Opler
&
Cournos,
1995,
DiBlasio
&
Belcher,
1995).
The

National
Center
for
Law
and
Economic
Justice
notes
that
34.2%
of
single
female

households
are
poor
while
17%
of
single
female
households
are
impoverished
(2011).
As

Jencks
observed
"married
couples
hardly
ever
become
homeless
as
long
as
they
stick

together"
(1994).

Other
Risk
Factors

Homelessness in Knoxville and Knox County, 2011-2012

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