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Strategic Action Plan on Homelessness

U.S. Department of Health and Human Services: Strategic Action Plan on Homelessness

U.S. Department of Health and Human Services Michael O. Leavitt, Secretary

Report from

the Secretary’s Work Group

on Ending Chronic Homelessness

U.S.Department of Health and Human Services:

Table of Contents

Executive Summary                                                                                  

Strategic Action Plan Framework

Chapter 1:           Overview of the Strategic Action Plan

Chapter 2:           The Strategic Action Plan in Detail

Chapter 3:           What’s New in the Strategic Action Plan

Chapter 4:           Progress Made Since 2003

A      Overview of Programs Operated by the U.S. Department of Health and Human Services That May Serve Persons Experiencing Homelessness

B      U.S. Department of Health and Human Services Resources on Homelessness

C    Acronym Glossary

D    Membership of the Secretary’s Work Group on Ending Chronic Homelessness

E     Comparison of Goals and Strategies: 2003 Strategic Action Plan and 2007 Strategic Action Plan

Strategic Action Plan on Homelessness 

EXECUTIVE SUMMARY

Each year, approximately one percent of the U.S. population, some 2-3 million individuals, experiences a night of homelessness that puts them in contact with a homeless assistance provider, and at least 800,000 people are homeless in the United States on any given night.  The population who experiences homelessness is a heterogeneous group, and includes single individuals, families with children, and unaccompanied runaway and homeless youth.  While interventions to interrupt and end homelessness may vary across groups, ending homelessness permanently requires housing combined with the types of services supported by programs operated by the U.S. Department of Health and Human Services (HHS). 

HHS is the United States government's principal agency for protecting the health of all Americans and supporting the delivery of essential human services, especially for those who are least able to help themselves.  As such, the delivery of treatment and services to persons experiencing homelessness is included in the activities of the Department, both in five programs specifically targeted to homeless individuals and in fourteen non-targeted, or mainstream, service delivery programs.  The coordination of these services, both within the Department, as well as with our Federal partners who provide housing and complementary service programs, is a critical component of achieving the goal of preventing and ending homelessness. 

The U.S. Department of Health and Human Services has developed the Strategic Action Plan on Homelessness to outline a set of goals and strategies that will guide the Department’s activities related to homelessness over the next several years.  This strategic action plan serves as the next iteration of the strategic action plan released in 2003, Ending Chronic Homelessness: Strategies for Action, which outlined the Department’s strategy for contributing to the Administration goal of ending chronic homelessness.  The intent of this new plan is to refine the goals and strategies of the 2003 Plan to reflect the changing set of challenges and priorities four years after the development of the first plan. 

Goal 1:   Prevent episodes of homelessness within the HHS clientele, including individuals and families

Goal 2:    Help eligible, homeless individuals and families receive health and social services

Goal 3:    Empower our state and community partners to improve their response to individuals and families experiencing homelessness

Goal 4:    Develop an approach to track Departmental progress in preventing, reducing, and ending homelessness for HHS clientele

Goal 1:      Prevent episodes of homelessness within the HHS clientele, including individuals and families

Strategy 1.1            Identify risk and protective factors to prevent episodes of homelessness for at-risk populations

Strategy 1.2            Identify risk and protective factors to prevent chronic homelessness among persons who are already homeless

Strategy 1.3            Develop, test, disseminate, and promote the use of evidence-based homelessness prevention and early intervention programs and strategies

Goal 2:      Help eligible, homeless individuals and families receive health and social services

Strategy 2.1            Strengthen outreach and engagement activities

Strategy 2.2            Improve the eligibility review process

Strategy 2.3            Explore ways to maintain program eligibility

Strategy 2.4            Examine the operation of HHS programs, particularly mainstream programs that serve both homeless and non-homeless persons, to improve the provision of services to persons experiencing homelessness

Strategy 2.5            Foster coordination across HHS to address the multiple problems of individuals and families experiencing homelessness

Strategy 2.6            Explore opportunities with federal partners to develop joint initiatives related to homelessness, including chronic homelessness and homelessness as a result of a disaster

Goal 3:      Empower our state and community partners to improve their response to individuals and families experiencing homelessness

Strategy 3.1            Work with states and territories to effectively implement Homeless Policy Academy Action Plans

Strategy 3.2            Work with governors, county officials, mayors, and tribal organizations to maintain a policy focus on homelessness, including homelessness as a result of a disaster

Strategy 3.3            Examine options to expand flexibility in paying for services that respond to the needs of persons with multiple problems

Strategy 3.4            Encourage states and localities to coordinate services and housing

Strategy 3.5            Develop, disseminate and utilize toolkits and blueprints to strengthen outreach, enrollment, and service delivery  

Strategy 3.6            Provide training and technical assistance on homelessness, including chronic homelessness, to mainstream service providers at the state and community level

Goal 4:      Develop an approach to track Departmental progress in preventing, reducing, and ending homelessness for HHS clientele

Strategy 4.1            Inventory data relevant to homelessness currently collected in HHS targeted and mainstream programs; including program participants’ housing status

Strategy 4.2            Develop an approach for establishing baseline data on the number of homeless individuals and families served in HHS programs

Strategy 4.3            Explore a strategy to track improved access to HHS mainstream and targeted programs for persons experiencing homelessness, including individuals experiencing chronic homelessness

Strategy 4.4            Coordinate HHS data activities with other federal data activities related to homelessness

Overview of the Strategic Action Plan

Introduction

Each year, approximately one percent of the U.S. population, some 2-3 million individuals, experiences a night of homelessness that puts them in contact with a homeless assistance provider, and at least 800,000 people are homeless in the United States on any given night (Burt et al 2001).  Persons experiencing homelessness can benefit from the types of services supported by the programs offered by the U.S. Department of Health and Human Services (HHS).  Among this population, there are several key subgroups, including: 

• Chronically Homeless .  Of the 2-3 million persons who experience homelessness annually, ten percent have been identified as chronically homeless due to their protracted spells of homelessness and the duration of their homelessness history.  On any given night, this group will represent almost half of those who are homeless (Kuhn & Culhane 1998; Metraux et al. 2001).  This subgroup has been identified as the long-term, or chronically homeless.  HHS, the U.S. Department of Housing and Urban Development (HUD), the U.S Department of Veterans Affairs (VA) and the U.S. Interagency Council on Homelessness (USICH) have agreed on the following definition of chronically homeless:  “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.” 
• Homeless Families.   Data from the National Survey of Homeless Assistance Providers and Clients estimates that in 1998, families comprised 34 percent of the homeless population; 23 percent were children and 11 percent were adults in homeless families (Burt et al 1999).  In a given year, this means 420,000 families, including 924,000 children, experience homelessness in the United States. For the purposes of this Plan, a homeless family is defined as one or two adults accompanied by at least one minor child who are either not housed or who have had recent periods during which they lacked housing.  
• At-Risk Individuals.   There are a number of other types of individuals who may be at-risk for becoming homeless or chronically homeless.  For example, the annual prevalence of homelessness among adolescents is estimated at between 5.0 and 7.6 percent among youth aged 12 to 17, and evidence suggests that adolescents are the single age group most at risk for experiencing homelessness (Ringwalt, et al 1998; Robertson & Toro 1998).  For the purposes of this Plan, homeless youth are defined as persons between the ages of 16-24 who do not have familial support and are unaccompanied – living in shelters or on the street.  Other vulnerable groups at-risk of homelessness include individuals with disabilities, immigrants, persons leaving institutions (e.g., incarceration, inpatient care for psychiatric or chronic medical conditions), youth aging out of foster care, frail elderly, persons experiencing abuse, and disaster victims. 

HHS and Homelessness

The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and supporting the delivery of essential human services, especially for those who are least able to help themselves.  The Department is the largest grant-making agency in the federal government, and the Medicare program alone is the nation's largest health insurer (http://www.hhs.gov/about/whatwedo.html).   The programs and activities sponsored by the Department are administered by eleven operating divisions that work closely with state, local, and tribal governments.  Many HHS-funded services are provided at the local level by state, county or tribal agencies, or through private sector and community and faith-based grantees.

HHS’ work in the area of homelessness fits well with the Department’s mission and priorities.  The principals that form the philosophical underpinnings of the Secretary’s 500 Day Plan are applicable to persons experiencing homelessness, particularly the first principal which reads “care for the truly needy, foster self-reliance”.  Additionally, the Department seeks to further the President’s New Freedom Initiative to promote participation by all Americans with disabilities, including mental disabilities in their communities.  One of the goals in the report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America outlines the need for stable housing as a requirement for enabling individuals and families with mental illness to fully participate in their treatment and their communities.  The Department’s focus on homelessness is consistent with this recommendation.

Ending homelessness requires housing combined with the types of services supported by HHS programs.  The delivery of treatment and services to persons experiencing homelessness are included in the activities of the Department, both in five programs specifically targeted to homeless individuals and in twelve non-targeted, or mainstream, service delivery programs (see Table 1 below).  The targeted programs are much smaller in scope, but are designed specifically for individuals or families who are experiencing homelessness.  Mainstream programs are designed to serve those who meet a set of eligibility criteria, which is often established by individual states, but are generally for use in serving low-income populations.  Very often, persons experiencing homelessness may be eligible for services funded through these programs.  Because the resources available for the mainstream programs are so much greater than the resources available for the targeted homeless programs, HHS has actively pursued an approach of increasing access to mainstream services for persons experiencing homelessness.  

Table 1. HHS Programs Relevant to Persons Experiencing Homelessness 

* The Title V/Surplus Property program involves the transfer of surplus federal property from HHS to a homeless assistance provider, and the program does not have a line item budget.

HHS Response to Homelessness: 2001-2006

An Environment for Change.   In 2001, the Secretaries of HHS and HUD met and committed to a collaboration that capitalized on the expertise of HHS in service delivery and the expertise of HUD in housing.  A leading concern was for the services funded by HHS to be more accessible to eligible homeless persons residing in HUD-funded housing.  Subsequently, HHS, HUD and VA explored goals and activities of mutual interest and concluded that collaboration was best achieved by adopting a specific and targeted focus on the issue of long term and repeated homelessness.  Concurrently, in 2002, the Administration revitalized the U.S. Interagency Council on Homelessness (USICH) to coordinate the federal response to homelessness across twenty federal departments and agencies, and to create a national partnership at every level of government and the private sector, with the goal of reducing and ending homelessness across the nation.  The final development of major significance came in the release of the Administration’s budget for fiscal year 2003, where President George W. Bush officially endorsed ending chronic homelessness as a goal of his Administration.  

The Secretary’s Work Group on Ending Chronic Homelessness.   In support of the articulated Administration goal of ending chronic homelessness, senior leadership within HHS established a Departmental work group in 2002 and tasked the group with developing a strategic action plan that would articulate a comprehensive approach for enabling the Department to better serve individuals experiencing chronic homelessness.  This work group, entitled the Secretary’s Work Group on Ending Chronic Homelessness , comprises senior leadership from seven operating divisions and numerous staff divisions within the Office of the Secretary and has expanded to encompass more offices as the Work Group has matured (see Figure 1).

Figure 1.  Members of the Secretary’s Work Group on Ending Chronic Homelessness

Immediate Office of the Secretary

Administration for Children and Families

Administration on Aging

Centers for Medicare and Medicaid Services

Health Resources and Services Administration

National Institutes of Health

• Substance Abuse and Mental Health Services Administration

Program Support Center

Center for Faith-Based and Community Initiatives

Office on Disability

Office of the Assistant Secretary for Resources and Technology

Office of the Assistant Secretary for Legislation

Office of the Assistant Secretary for Planning and Evaluation

Office of Intergovernmental Affairs

Office of the General Counsel

In early 2002, the Secretary’s Work Group on Ending Chronic Homelessness was charged with designing a plan to:

• improve access to treatments and services;
• improve coordination across these services;
• identify strategies to prevent additional episodes of chronic homelessness; and
• itemize accountability and evaluation processes.

The strategic action plan developed by the Work Group, entitled Ending Chronic Homelessness: Strategies for Action , was released in 2003.   The purpose of the 2003 Plan was to define the chronically homeless population and itemize the service needs of the population; analyze the response of HHS mainstream assistance programs to these needs; specify outcomes and objectives that would improve the response of mainstream programs to the chronically homeless population; and offer actions the agencies could take that would improve access to and coordination of services.  The 2003 Plan has served as the framework for developing and implementing activities across the Department related to chronic homelessness.  The general premise of the strategic action plan posits that homelessness is a complex social problem, and ending chronic homelessness requires housing combined with the types of services supported by the programs funded and operated by HHS.  The goals outlined within the strategic action plan provided a course of action for the Department to follow in order to improve access to needed health and social services for individuals experiencing chronic homelessness, empower states to improve their response to individuals experiencing chronic homelessness, and to prevent future episodes of homelessness within HHS clientele.

From its inception to the present time, the Secretary’s Work Group has met regularly in order to discuss policy issues related to chronic homelessness, as well as homelessness among families and youth, review progress, and report about key activities occurring in the various operating divisions.  The Work Group has developed an activities tracking matrix, which allows agencies to chart homeless-related activities under the specific goals and strategies outlined in the Plan noted above.  The matrix provides Work Group members with a way to measure progress towards achieving these goals and strategies and also provides a simple measure of the level of activity within each key area of focus. 

Since 2003, the Department has worked in partnership with the states, other federal Departments, and the U.S. Interagency Council on Homelessness to advance the goals outlined in the strategic action plan.  As the plan approached its third anniversary, the Work Group collectively reviewed the Department’s progress towards achieving the goals outlined in the plan, and has concluded that significant progress has been made towards certain goals and strategies, where other goals and strategies needed additional focus.  Furthermore, though the 2003 Strategic Action Plan focuses solely on the chronically homeless population, the scope of work and focus of the Work Group was actually much broader, and includes activities that focus on homeless families with children, as well as homeless youth.  The Work Group concluded that the Department would benefit from a new plan that would provide a framework for future efforts.  The intent of this revision is not to usurp or replace the original strategic action plan, but rather to refine the goals and strategies to reflect the changing set of challenges and priorities three years after the development of the first plan. 

Key Events Shaping Strategic Action Plan Revision

Between 2001 and 2006, several key events and activities guided the development of the 2007 Plan.  First, HHS partnered with HUD, VA, ICH, the U.S. Department of Labor (DOL), and the U.S. Department of Education (ED) to fund nine HomelessPolicy Academies that were designed to bring together state-level program administrators and homeless service providers in order to develop state-specific action plans designed to increase access to mainstream resources for persons experiencing homelessness.  Five Policy Academies focused on chronic homelessness, and in response to demand, the remaining four Academies focused on homeless families with children .  To date, every state (including the District of Columbia) and U.S. Territory has attended a Homeless Policy Academy.   HHS, along with our federal partners, has provided significant technical assistance resources to these jurisdictions to assist them in the implementation of their Policy Academy action plans over the past several years. 

Another key effort extending into the states is the work of the ICH to encourage the development of State Interagency Councils on Homelessness as well as state and local ten-year planning processes to end chronic homelessness .  As part of the Council’s strategy to create intergovernmental partnerships to end homelessness, Governors of 53 states and territories have taken steps to create a state-level ICH, while over 280 Mayors and County Executives have initiated a ten-year planning process.  Currently, many of the states and Territories are leveraging the support and infrastructure of the ICH and the Homeless Policy Academies to strengthen and coordinate their State Interagency Councils on Homelessness, Homeless Policy Academy teams and state and local planning processes that may already be institutionalized through HUD’s Continuum of Care process.

A cornerstone effort of the increased focus on chronic homelessness was the development of the Collaborative Initiative to Help End Chronic Homelessness, also known as the Chronic Homelessness Initiative (CHI), an innovative demonstration project coordinated by the ICH and jointly funded by HUD, HHS (SAMHSA and HRSA) and the VA.  Recognizing that homelessness is an issue that cuts across various agencies in the federal government, this unique effort across the Department offered permanent housing and supportive service funding through a consolidated application process.  Successful applicants described an integratedand comprehensive community strategy to use funding sources, including mainstream service resources, to move chronically homeless individuals from the streets and emergency shelters into stable housing. Once housed, the residents would be able to access the range of services needed to promote and maintain greater self-sufficiency.  The CHI is important because it operationalizes many of the key goals and strategies outlined in both the original and revised strategic action plans; for example, use of interagency partnerships on both local and federal levels, increasing the effectiveness of integrated systems of care, and the use of mainstream resources.  In October 2003, 11 grantees received funding for three years, FY 2003-2005.  HHS funding totaled $30 million for the three-year period. 

Another key event that influenced the Secretary’s Work Group was Hurricane Katrina , which occurred in August 2005.  A special meeting of the Secretary’s Work Group was held in September 2005 on this topic.  At this meeting, a literature review compiled for the meeting was used to guide discussion pertaining to: the key players during the hurricane; housing and health issues; the impact on the historically homeless; and data pertaining to and lessons learned from previous disasters.   Furthermore, agency representatives at the meeting described their experiences providing concrete assistance during Hurricane Katrina.  Lessons learned from this disaster have led the Department to carefully consider how HHS should prepare for and respond to homelessness and human service needs in future disasters, and how the structure of the Work Group might be used as a tool for future natural disasters.

Finally, one of the original charges to the Work Group was to “itemize accountability and evaluation processes.”  This called for establishing monitoring and evaluation benchmarks pertaining to chronic homelessness.  However, the absence of data to inform the Department about a baseline suggested considerable developmental work would be needed before empirical benchmarks could be established.  Over the past several years, the ability to demonstrate results towards ending and reducing homelessness in a quantitative fashion has increased, and thus, where the original plan included a recommendation for this work, a more focused effort to develop data and performance measurements will be critical to documenting future success and is a key component to the revised strategic action plan.

HHS 2007 Homelessness Strategic Action Plan

Purpose of Plan .   The purpose of the 2007 Plan is to provide the Department with a vision for the future in the form of a formal statement that addresses how individuals, youth, and families experiencing homelessness can be better served through the coordinated administration of Departmental resources.  This Plan allows the Secretary to highlight the accomplishments that have been achieved over the past several years, as well as to chart a course for future activities for the Department that builds on the current efforts.  The revised Plan covers a five-year time frame, from FY 2007-FY 2012.

Audience for the Plan . The 2007 Plan has both internal and external audiences and thus may be utilized in various ways.  The internal audience consists of the HHS operating and staff divisions that have approved the Plan and agreed to implement it as is appropriate to their respective agency/division.  For example, the Plan may impact HHS agencies’ strategic and performance plans, program activities, training, data collection/performance measurement, and/or budgets. 

The external audience will be wide-ranging, including HHS grantees and other providers of homeless assistance services, participants of the state Homeless Policy Academies, the developers of state/local 10-year plans to end homelessness, participants of HUD’s Continuum of Care process, advocacy/interest groups, Congress/legislative branch, states, researchers, federal partners, and the U.S. Interagency Council on Homelessness.

Approach Used In Developing the 2007 Plan.   In order to develop the 2007 Plan, a Strategic Action Plan Subcommittee was formed, consisting of representatives from the various agencies participating in the Secretary’s Work Group.  This subcommittee, working in close partnership with the entire Work Group, utilized an iterative process to review recent accomplishments and to develop recommendations for the goals and strategies to be the framework of the 2007 Plan.  Throughout the development of the revised goals and strategies, as well as the narrative text of the 2007 Plan, the subcommittee reported to the full Work Group and revised the plan based on the feedback of the full Work Group.  The 2007 Plan was circulated throughout the HHS operating and staff division heads prior to being finalized by the Department and made public.

Major Plan Revisions.   As a result of the above process, the following major changes for the 2007 Plan were incorporated:

• Families/At-Risk Individuals.   The scope of the Plan was broadened to incorporate families with children and individuals at-risk of homelessness, particularly youth, while maintaining a continued commitment to ending chronic homelessness.  By including a broader range of populations in the Plan, the Department is acknowledging that effectively preventing chronic homelessness requires the two-pronged strategy of ending the homelessness cycle for those who are already homeless, and the prevention of new episodes of homelessness for those who are currently housed, but who are at risk of becoming homeless.  The significant work related to addressing homelessness for families and individuals is on-going and is critical to our mission as a Department. 
• Federal Agency Collaboration. Homelessness is a complex social problem that will require solutions to be developed in partnership, not simply across HHS, but across the multiple federal agencies that dedicate resources towards ending homelessness, as well as our state and local partners.  In recognition of the critical nature of these partnerships, specific strategies were added to the Plan to encourage intradepartmental and interdepartmental coordination and collaboration with other federal agencies who operate housing and service programs that complement HHS programs;
• PolicyAcademyFollow-up .  To date, every state (including the District of Columbia) and U.S. Territory has attended a Homeless Policy Academy and is working to implement a state Action Plan intended to improve access to mainstream health and human services and employment opportunities that are coordinated with housing for persons who are experiencing homelessness.  Strategies in the 2007 Plan were revised to reflect the second phase of the Homeless Policy Academies, including providing technical assistance to the states and territories around effective implementation of their Action Plans and sustaining their momentum in addressing homelessness in their jurisdictions;
• Primary Prevention .  A new strategy was added to the Plan that emphasizes preventing first-time homelessness for at-risk populations;
• Data/Measurement .  A new and separate goal about data and measurement, as well as strategies that address the issue of developing a homelessness data infrastructure within HHS pertaining to targeted and mainstream programs, was added to the Plan.
• Disasters.   A new strategy was added specifically referring to working with federal, state, local partners and tribal organizations around policies pertaining to addressing homelessness in the context of a disaster.  

Measuring Work Group Outcomes.   The Secretary’s Work Group will continue to meet regularly.  Prior to each of these meetings, the operating and staff divisions that participate in the Work Group will be asked to update the activities tracking matrix.  This matrix includes key activities that the agencies are implementing related to homelessness and is organized by the goals and strategies outlined in the strategic action plan.  Each activity listed in the matrix includes information about the activity, its timeframe, and its outcome or expected outcome.  The matrix can then be used as an analytical tool to examine the Department’s progress related to the activities by goal or strategy, as well as by agency.  Each updated matrix is distributed to those attending the Secretary’s Work Group meetings.  In addition, participating agencies report orally on their key activities at each meeting; meeting minutes are recorded and sent to participants.

The chapters that follow provide further elaboration on various aspects of the 2007 Plan.  Chapter two will outline the 2007 Strategic Action Plan in detail, providing examples of activities that might be undertaken in support of the goals and strategies proposed in the Plan.  Chapter three highlights what is new in the plan and the rationale for expanding the existing goals and strategies established in 2003.  The fourth chapter provides an overview of progress made by the Department towards achieving the goals outlined in the 2003 Plan.  Finally, a series of appendices provide supporting information to the strategic action plan.  Appendix A provides an overview of the HHS programs that may serve persons currently experiencing, or at risk of, homelessness.  A list of departmental homelessness web resources and research reports relevant to homelessness are included as Appendix B.  Additional appendices provide a list of commonly used acronyms (Appendix C), a membership list of the Secretary’s Work Group, including the staff list of the Strategic Action Plan Subcommittee (Appendix D), and finally, a crosswalk of the goals and strategies included in the 2003 and 2007 Plans (Appendix E).   

The Strategic Action Plan in Detail

This chapter delineates all the goals and strategies identified in the 2007 Strategic Action Plan.  The chapter also provides, under each strategy, a few examples of possible activities the Department could implement in order to fulfill a given strategy.  It is assumed throughout this document that no strategies, or activities, will be implemented without seeking and attaining all relevant legislative and/or regulatory changes needed to ensure that all programs within HHS continue to operate within their given authority and mission.  It is also assumed that, to the extent the strategies seek to impose any requirements on applicants as conditions of given awards, before doing so, programs will confirm that their authorizing authority and program/administrative regulations permit such imposition of conditions.  It is further assumed that no proposals will be implemented without resolving any inherent budget implications.

The goals, strategies, and examples of activities are as follows:

Goal 1:  Prevent episodes of homelessness within thehhs clientele, including individuals and families

Strategy 1.1    Identify risk and protective factors to prevent episodes of homelessness for at-risk populations

Examples of Activities:

o       Identify and promote the use of effective, evidence-based homelessness prevention interventions, such as discharge,release, or transition planning; intensive case management; access to protection orders, legal assistance and safety planning for victims of abuse; landlord mediation, and family strengthening, along with organizational and cross-organizational level strategies.

o       Promote organizational development and horizontal coordination between agencies such as housing, HIV/AIDS services/prevention, mental health and substance abuse treatment and prevention, and criminal justice to provide integrated comprehensive services to prevent homelessness.

o       Examine how HHS agencies can synthesize, sponsor, or conduct epidemiological, intervention, and health services research on risk and protective factors for homelessness and identify preventive interventions that could be provided in health care and human services settings that are effective at preventing at-risk persons from entering a pattern of residential and personal instability that may result in homelessness.

o       Encourage states and communities to experiment with various approaches to creating a coordinated, comprehensive approach to addressing homelessness prevention (e.g. establish an infrastructure that supports prevention activities, allows flexibility in the use of funds, and fosters the development of systematic relationships between providers and across systems of care).       

Strategy 1.2    Identify risk and protective factors to prevent chronic homelessness among persons who are already homeless

o       Review and synthesize the published and non-published literature to identify risk factors associated with chronic homelessness and protective factors that reduce the risk for chronic homelessness.

o       Examine how HHS can sponsor or conduct epidemiological, intervention, and health services research on risk and protective factors for chronic homelessness and to identify preventive interventions that could be provided in health care and human services settings that are effective at preventing currently homeless individuals from becoming chronically homeless.

o       Develop targeted interventions preventing chronic homelessness specifically for use in HHS programs that are serving currently homeless persons, such as PATH, Treatment for Homeless grantees, and Health Care for the Homeless programs. 

Strategy 1.3    Develop, test, disseminate, and promote the use of evidence-based homelessness prevention and early intervention programs and strategies

Examples of Activities:                    

o       Sponsor, synthesize, or conduct research and evaluation on interventions that focus on primary, secondary, and tertiary homeless prevention strategies and health treatment regimens, as well as the organization, effectiveness, and cost of such preventive interventions.

o       Identify and develop workforce development strategies and program incentives that foster the adoption and implementation of evidence-based homelessness prevention programs and practices.

o       Promote the availability of technical assistance and training documents on services and policy issues related to homelessness prevention via internet access, distribution at relevant meetings, and other settings offering instruction on the issue of homelessness, such as SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP) and other listings of effective program models.

Goal 2: Help eligible, homeless individuals and families receive health and social services

Strategy 2.1    Strengthen outreach and engagement activities      

o       Encourage mainstream programs that support outreach and case management to identify individuals and families experiencing homelessness as potentially eligible candidates for these services.

o       Identify and promote innovative outreach and engagement activities successfully operating in existing programs, such as mobile health clinics, outreach workers who function as case managers, and innovative clinic-based programs that operate through the Health Care for the Homeless Program and the PATH program. 

o       Support empirical studies and demonstration projects that develop and test the effectiveness of outreach and engagement strategies for various populations.

Strategy 2.2    Improve the eligibility review process

o       Develop tools for providers that simplify or streamline the eligibility review process, similar to the Health Resources and Services Administration (HRSA)-funded publication entitled Documenting Disability: Simple Strategies for Medical Providers , which provides a partnership tool for the Social Security Administration’s Homeless Outreach Projects and Evaluation (HOPE) program, focused on assisting eligible, chronically homeless individuals in applying for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits.  

o       Promote the inclusion of homeless assistance programs among the entities conducting eligibility and enrollment functions for mainstream programs.

Strategy 2.3    Explore ways to maintain program eligibility

o       Explore state practices related to policies designed to suspend, rather than terminate, Medicaid eligibility for individuals who are institutionalized so that the eligibility process does not need to be initiated over again upon release.

Strategy 2.4    Examine the operation of HHS programs, particularly mainstream programs that serve both homeless and non-homeless persons, to improve the provision of services to persons experiencing homelessness

o       Inventory mainstream HHS programs, identifying barriers to access for persons experiencing homelessness, and propose strategies to reduce and eliminate these barriers to services. 

o       Identify regulatory barriers and other challenges faced by states as they implement their Homeless Policy Academy state action plans to increase access to mainstream resources.

Strategy 2.5    Foster coordination across HHS to address the multiple problems of individuals and families experiencing homelessness

o       Continue to use the regularly scheduled meetings of the Secretary’s Work Group on Ending Chronic Homelessness as a means to promote collaboration and coordination across the Department and develop joint activities and approaches to addressing various aspects of homelessness.

o       Work with HHS program agencies to ensure that the Department’s disaster planning efforts address the special needs of the elderly, individuals with disabilities, and other vulnerable populations affected by disasters.  Where feasible and appropriate in HHS programs, identify ways to mitigate the long-term impact of homelessness as a result of disasters.

o       Develop initiatives which can enable NIH research to be linked to pilot projects and programs within HHS to establish the effectiveness of such projects and programs and expand the evidence-base on what works.

Strategy 2.6    Explore opportunities with federal partners to develop joint initiatives related to homelessness, including chronic homelessness and homelessness as a result of a disaster

o       Promote joint initiatives through interagency cooperative agreements, pooled funding for special projects or evaluations of mutual interest or benefit. 

o       Jointly develop policy or program guidance to assure consistency with other Departments’ policies and statutory and programmatic definitions, and/or consider joint issuance of key policy or programmatic guidance, especially where such issuance has the potential of having a significant impact on another Department’s clients and/or grantees.

Strategy 3.1    Work with states and territories to effectively implement Homeless Policy Academy Action Plans

o       Encourage federal agencies to incorporate language into their program funding guidance that authorizes applicants to use HHS and other federal funds to create and/or support programmatic strategies that formulate an integrated safety net for poor and disabled individuals and families, where appropriate.  Language should also include a requirement that provides for the ability to evaluate the effectiveness of the coordinated efforts.

o       Support state grantees to seek appropriate HHS funds to support the implementation of their Policy Academy action plans to address homelessness.

o       Support state efforts to expand Policy Academy Action Plans to address the needs of HHS clientele including homeless families and individuals at risk of homelessness, particularly youth and victims of abuse.

Strategy 3.2    Work with governors, county officials, mayors, and tribal organizations to maintain a policy focus on homelessness, including homelessness as a result of a disaster

Examples of Activities:  

o       Encourage national intergovernmental organizations to hold sessions with a homelessness policy focus at their annual and/or winter meetings (e.g., U.S. Conference of Mayors, National Association of Counties, National Conference of State Legislatures, National Governors Association, National Council of State Governments, National Association of State Mental Health Program Directors, etc.).

o       Share information with the national intergovernmental organizations that can be used in their newsletters and other communications with their members (e.g., through a homelessness clearinghouse website that provides links not only to relevant HHS programs but also to state and local activities that could serve as “best practice” models).

Strategy 3.3    Examine options to expand flexibility in paying for services that respond to the needs of persons with multiple problems

o       Investigate regulatory barriers faced by grantees utilizing HHS funding that impede the ability of grantees to provide timely, comprehensive services to families and individuals experiencing homelessness.  Examine options for reducing identified regulatory barriers. 

o       Identify “lessons learned” from the jointly funded Chronic Homeless Initiative (CHI) pilot program which allowed for pooled funds from mainstream programs and targeted homeless programs to create a collaborative and comprehensive approach to addressing the problems of homelessness.

o       Develop and distribute a primer that will help explain what medical, behavioral health, and support services that would benefit individuals who are homeless can be reimbursed by Medicaid.

Strategy 3.4    Encourage states and localities to coordinate services and housing

o       Encourage states and communities to establish approaches, such as partnerships, to create a coordinated, comprehensive system of services to address homelessness, including chronic homelessness.  Such approaches include establishing an infrastructure that forges systemic relationships among providers for effective client referral and treatment, more effective leveraging of fiscal and human resources, cross-system training, and increased focus on sustainability of activities.

o       Encourage applicants’ use of grant funds to support community infrastructure development efforts, including expenses for staff associated with partnership activities, incentive funds, and other funding mechanisms that can support infrastructure development efforts.

o       Where feasible, encourage Federal agencies to develop policy or guidance language encouraging states and communities to address the needs of their homeless residents by coordinating services and housing in a comprehensive way.

Strategy 3.5    Develop, disseminate and utilize toolkits and blueprints to strengthen outreach, enrollment, and service delivery

o       Continue interagency collaborations between HHS program agencies to develop tools that are designed for use by both homeless service providers as well as individuals who are homeless.

o       Complete, disseminate, and promote the use of toolkits developed by agencies (e.g., SAMHSA’s Treatment Improvement Protocol (TIP) #42 Substance Abuse Treatment for Persons With Co-Occurring Disorders , Assertive Community Treatment and Integrated Dual Disorders Treatment, and Permanent Supportive Housing.

Strategy 3.6    Provide training and technical assistance on homelessness, including chronic homelessness, to mainstream service providers at the state and community level

o       Continue to maintain jointly-funded collaborations to support state and community partners to implement their homeless Policy Academy action plans (e.g., SOAR Training Initiative, jointly funded HRSA Policy Academy contract, jointly funded SAMHSA Policy Academy Technical Assistance contract, jointly funded ACF Homeless Families Policy Academies).

o       Utilize national meetings of HHS grantees to highlight promising practices and other information to help states implement their action plans through workshops, discussion sessions and transfer peer-to-peer learning to mainstream providers.

Strategy 4.1    Inventory data relevant to homelessness currently collected in HHS targeted and mainstream programs; including program participants’ housing status

o       Inventory and compile the data currently collected within the Department relevant to homelessness; domains may include: OPDIV, title of data source; population included; method of data collection; web link to the data source (or directly to data that are publicly available), and strengths and limitations, among others.

o       Review data elements relevant to homelessness and housing status currently collected across HHS programs in order to identify opportunities to compare data across programs, gaps in data collection, as well opportunities to link data across administrative systems. 

Strategy 4.2    Develop an approach for establishing baseline data on the number of homeless individuals and families served in HHS programs

o       Support a research project to begin the exploration of available data that could be used to identify the number of homeless persons currently accessing HHS mainstream programs by investigating which states currently collect housing status data from applicants of Medicaid and Temporary Assistance for Needy Families (TANF), the two largest HHS mainstream programs that may serve individuals or families experiencing homelessness.

o       Explore the feasibility of collecting data regarding the housing status or program participants of HHS mainstream service programs.

Strategy 4.3    Explore a strategy to track improved access to HHS mainstream and targeted programs for persons experiencing homelessness, including individuals experiencing chronic homelessness

o       Partner with all HHS agencies that support homeless programs and identify incentives and standard policy language that requires recipients of federal funds to document attempts at improved access to mainstream target programs.

o       Collaborate with states and local entities to support efforts to document homelessness and share data with HHS as agreed to by partners.  Ensure that any agreements developed are feasible and that the response burden does not exceed that which is deemed reasonable and negotiable by all parties.

Strategy 4.4    Coordinate HHS data activities with other federal data activities related to homelessness

o       Generate an inventory of all data elements utilized by various agencies in order to establish similarities and differences within each respective system.  Compare HHS inventory with the inventory of other Federal agencies, such as HUD.

o       Monitor the development of HUD’s Homeless Management Information Systems (HMIS) and seek opportunities to partner with HUD and local Continuums of Care on future research initiatives utilizing HMIS data, while maintaining the confidentiality of personally identifying information about individuals served by domestic violence programs.

o       Disseminate the findings and results of HHS data collection efforts with Federal partners and collaborate on efforts to improve data quality on homelessness.

What’s New in the Strategic Action Plan

The primary purpose for the development of the 2007 Strategic Action Plan is to refine the goals and strategies outlined in the 2003 Strategic Action Plan in order to reflect the progress that has been made, and has not been made, in the four years since the development of the initial HHS strategic action plan on homelessness.  There are two new elements that represent the greatest departure from the 2003 Strategic Action Plan and deserve to be highlighted for their magnitude and breadth.  First, the Department has broadened the scope of the plan to address issues faced by a clientele that encompasses not only chronically homeless individuals, but also homeless families with children and runaway and homeless youth.  Second, the Department has added a new goal that focuses exclusively on issues of data and measurement; specifically, the Department’s ability to document progress in preventing, reducing, and ending homelessness for the HHS clientele.  This new goal related to data and measurement includes strategies that seek to identify what types of data are needed to measure progress in addressing homelessness, as well as methods by which to obtain this data.  It is important to note that while these new goals and strategies will broaden the focus of the Department’s activities related to ending and reducing homelessness, it is not the intention of the Department to retreat from the initial 2003 commitment to help end chronic homelessness.  Rather, the expanded scope will reflect the work related to addressing homelessness for families and children, as well as youth, which is already ongoing and critical to the mission of the Department of Health and Human Services, in addition to the Departmental priority to end chronic homelessness. 

This chapter will summarize how the two major changes have been incorporated into the framework of the strategic action plan, and will provide the rationale for the expansion of the plan in these two new directions.  In addition, this chapter will briefly discuss the other changes made to the strategic action plan that, while not as prominent in the goals-and-strategies framework as the two major changes mentioned above, are significant and warrant highlighting. 

Broadening the Plan to Incorporate a Focus on Homeless Families with Children and Youth

When the Secretary established the Secretary’s Work Group on Ending Chronic Homelessness in 2002, the Work Group was to report recommendations for a Department-wide approach that would contribute to the Administration’s goal of ending chronic homelessness and improve the Department’s ability to assist persons experiencing chronic homelessness.  As the title of the 2003 Strategic Action Plan indicates ( Ending Chronic Homelessness: Strategies for Action ) the focus of the Work Group was on chronic homelessness.  For the last three years, however, the Work Group has actively tracked the efforts of numerous components of HHS to improve access to treatment and services for all eligible groups, including chronically homeless individuals, homeless families with children, and homeless youth.  While chronic homelessness has remained a priority, the Department has also engaged in other homelessness related activities that affect families with children and youth, who make up a substantial portion of the HHS clientele.

The goals and strategies from the 2003 Strategic Action Plan framework specifically focused on chronic homelessness.  For example, the language in Goals 1 and 2 used the terms chronically homeless and chronic homelessness , and the same two terms were also used throughout the different strategies under all three goals.  In order to accurately capture the clientele served by all homelessness-relevant HHS programs, the Work Group decided that the plan would have to be broader in scope.  Therefore, the goals and strategies were edited to include families and youth, where applicable.  In general, phrases such as “chronically homeless individuals” were substituted by “homeless individuals and families” so as to be inclusive of families and children experiencing homelessness, while still including individuals experiencing homelessness, whether chronic or episodic.  However, in order to maintain chronic homelessness as a priority, the Work Group highlights chronic homelessness in a few different strategies in the new framework.  Additionally, the new Goal 4 (which will be discussed in more detail below) also takes a broader approach and applies to the whole of the HHS clientele, including individuals and families.

The Rationale

Evidence of the growing number of homeless families supports the expanded scope of the Department’s strategic action plan to include homeless families with children.  Findings from the research literature show that families are a significant subgroup that warrants specific attention and interventions that may differ from those that are successful in serving homeless individuals. 

According to the 1996 National Survey of Homeless Assistance Providers and Clients, 34 percent of all persons using homeless services were members of a homeless family (Burt et al 1999), though more recent studies (Shinn, et. al 1998) estimate that families make up roughly 40 percent of those who become homeless.  The U.S. Conference of Mayors Hunger and Homelessness Survey of 23 cities (2006), report that requests for shelter from homeless families increased by 5% over the previous year, with 59% of the 23 cities reporting an increase.  For the purposes of this strategic action plan, a homeless family is defined as one or two adults accompanied by at least one minor child who are either not housed or who have had periods during some recent time period during which they lacked housing.  A significant body of research documents the broad array of negative health and mental health outcomes experienced by both children and their mothers in association with episodes of homelessness.

Current research indicates that homeless families are more similar to poor housed families than to single homeless individuals (Burt, et al 1999; Bassuk et al 1996).  Several studies have compared housed and non-housed low-income families in an effort to document what characteristics or contextual factors influence a low-income family’s probability of experiencing homelessness.  While these studies each examine the experiences of homeless families in only one city, and therefore are not nationally representative, the studies report similar results.  In general, researchers have found that heads of homeless families have higher rates of victimization, mental illness, and substance abuse along with weaker social networks, less robust employment histories, and lower incomes than the heads of housed low-income families (Bassuk et al 1996; Bassuk et al 1997; Shinn et al 1998).  Additionally, homeless heads of household tend to be younger and tend to have younger children than their housed counterparts (Shinn et al 1998; Webb et all 2003).

In considering which families might be at greatest risk for homelessness, one must consider individual characteristics that might indicate a higher chance of experiencing homelessness, such as substance abuse or mental illness; family factors, such as the presence of violence in the home; as well as contextual factors, such as a lack of affordable housing in the community.  Other issues related to the causes and consequences of family homelessness, such as a family’s interaction with the child welfare or foster care systems, may be important as the dynamics of children and their parent(s) while they move through the shelter system may not be the same (Park et al 2004).  Fifty-five percent of the cities participating in the 2006 Hunger and Homelessness Survey report that families may have to separate in order to be sheltered (U.S. Conference of Mayors 2006).  Many studies have documented a large number of single homeless individuals, primarily women, who are parents but are no longer residing with their children (Burt et al 1999).  A number of other studies indicate that housing instability in childhood appears to be associated with adolescent homelessness, suggesting that housing stabilization for homeless or poorly housed families may contribute to the prevention of chronic homelessness (Robertson et al 1999; Park et al 2004).

Runaway and homeless youth, defined in the Runaway and Homeless Youth Act as “individuals who are not more than 21 years of age…for whom it is not possible to live in a safe environment with a relative and who have no other safe alternative living arrangement,” may have different needs than homeless youth who are still connected to their families due to runaway and homeless youth’s lack of adult supervision during a homeless episode.  Other youth who may be at-risk of homelessness include youth who are aging out of foster care or exiting the juvenile justice system (Farrow et al 1992).  After reviewing the range of estimates of the number of homeless youth, Robertson and Toro concluded that youth under the age of 18 may be at higher risk for homelessness than adults (1999).    

HHS operates a wide range of programs that may be accessed by homeless families with children and runaway and homeless youth.  The following is a list of HHS programs (both targeted and mainstream) that provide services to homeless families:

Expanding the scope of the strategic action plan to encompass family and youth homelessness will formalize the Department’s already ongoing efforts to assist homeless families with children and youth, as well as tie the work of the Department’s agencies closely to the Secretary’s goals and objectives for the Department as a whole. 

Adding a New Goal Focusing On Data and Performance Measurement

The 2003 Strategic Action Plan devoted one strategy (Strategy 2.9) to data and measurement issues, which read as follows: “Develop an approach for baseline data, performance measurement, and the measurement of reduced chronic homelessness within HHS.”  While this is an important strategy, a single strategy alone cannot encompass the many data and measurement issues related to homelessness that have been raised within the Department over the past three years.  For example, Strategy 2.9 did not address how the Department would measure progress in improving the access to mainstream services for eligible homeless clients.  It also did not address how HHS data activities would be coordinated with other federal department’s important data activities related to homelessness, such as the creation and utilization of HUD’s Homeless Management Information System (HMIS).  Therefore, an entirely new goal that contains four separate strategies and focuses exclusively on homelessness data issues and how they relate to tracking Departmental success in addressing the problem of homelessness for the HHS clientele was added to the 2007 Plan.

The new goal (Goal 4) was established to develop an approach to track Departmental progress in preventing, reducing, and ending homelessness for HHS clientele.  Strategy 4.1 encourages the Department to inventory homelessness related data that is currently collected in HHS targeted and mainstream programs, including the housing status of participants.  Strategy 4.2 promotes the development of an approach for establishing baseline data on the number of homeless individuals and families served in HHS programs, whereas Strategy 4.3 relates to developing a strategy by which to track improved access to HHS mainstream and targeted programs for persons experiencing homelessness.  The final strategy identifies collaboration with other Federal departments as a critical component of the Department’s homelessness data activities.

In order to measure progress in preventing, reducing, and ending homelessness, the Department needs to have data systems and performance measures at its disposal.  It has been the Department’s experience that it does not yet have an established data approach by which to track its success in addressing homelessness.  The Work Group believes that devoting an entire goal and set of objectives to data and performance measures related to homelessness will aid in the process of measuring the success of the strategic action plan.  There is a growing desire within the federal government to focus on results and to measure success by documenting progress.  This perspective can be seen within different HHS operating divisions’ strategic plans.  For example, the Health Resources and Services Administration (HRSA) strategic plan for fiscal years 2005-2010 ( http://www.hrsa.gov/about/strategicplan.htm ) discusses how the agency measures its progress by monitoring a variety of performance measures that are linked to the goals and objectives set out in the strategic plan.  In addition to performance measures, the HRSA strategic plan also discusses the need to assess results, program effectiveness, and strategies.  Likewise, there should be a Department-wide approach to measuring the effectiveness of the homeless assistance programs, and of the Department’s strategic action plan.  This new focus on data and measurement issues may also assist HHS homelessness programs with future Program Assessment Rating Tool (PART) reviews.

Furthermore, the Department has been pursuing a strategy over the past several years of increasing access to mainstream resources for eligible homeless individuals and families.  In the 2003 Strategic Action Plan the Work Group outlined sixteen strategies to reduce chronic homelessness, one of which was to “improve the transition of clients from homeless-specific programs to mainstream service providers.”  A cornerstone activity under this strategy has been the development and implementation of nine Homeless Policy Academies that were designed to bring together state-level program administrators and homeless service providers in order to develop state-specific action plans designed to increase access to mainstream resources for persons experiencing homelessness.  However, the key policy question, “Has HHS been successful at improving access to mainstream service programs?” cannot yet be answered because no baseline data are available.  At the federal level, most mainstream programs are not required to collect data related to the number of homeless clients served.  This lack of baseline information about the number of homeless individuals and families served in HHS mainstream programs makes it difficult, if not impossible, for HHS to document improvements in access.

There are a number of challenges in developing this kind of baseline data, particularly due to the fact that homelessness is a dynamic state; a person may be homeless today but housed tomorrow, thus causing fluidity in the number of program participants experiencing homelessness at any given point in time.  However, further exploration is warranted to improve the Department’s ability to develop measures related to increasing access to mainstream resources for persons experiencing homelessness.  It is also important to highlight that these data development efforts are likely to be fruitless if they are not coordinated with our federal partners.  As such, Strategy 4.4 emphasizes the importance of coordinating homelessness data activities within HHS with relevant data activities in other federal agencies and Cabinet-level departments such as HUD, VA, DOL, and the USICH.  Thus, while the Department will develop its own data strategies  internally, it will be paramount to also coordinate our efforts and integrate data across multiple Federal departments.

Additional Changes to the Plan

While the two major revisions discussed in detail above represent the most substantial changes to the plan, other smaller, yet significant changes have been made within the revised goals and strategies of the 2007 Plan.  These changes address the following issues:

• At-Risk Individuals and Primary Prevention
• Federal Agency Collaboration
• Policy Academy Follow-up

In addition to broadening the plan to address homelessness experienced by families with children, the new plan also incorporates populations who areat-risk of homelessness .  Vulnerable groups who may be at-risk of homelessness include individuals with disabilities, immigrants, persons leaving institutions (e.g., incarceration- including juvenile detention facilities, inpatient care for psychiatric or chronic medical conditions), youth aging out of foster care, frail elderly, persons experiencing abuse, and disaster victims.  By including the at-risk population in the Plan, the Department is acknowledging those who may be on the verge of becoming homeless and who could become the next generation of chronically homeless individuals.  Specifically, Strategy 3.1 in the new plan highlights the importance of identifying risk and protective factors to prevent episodes of homelessness for at-risk populations.  This new strategy was added to the Plan to emphasize the importance of preventing first-time homelessness for at-risk populations (i.e. primary prevention ).  The inclusion of at-risk populations further acknowledges that effectively preventing chronic homelessness requires the two-pronged strategy of ending the homeless cycle for those who are already homeless, and the prevention of new episodes of homelessness for those who are currently housed, but who are at risk of becoming homeless. 

The plan also contains new language and specific strategies about federal agency collaboration to encourage intra departmental and inter departmental coordination and collaboration across the federal government.  Federal collaboration was included in Goal 4 as a specific strategy for data activities, but a separate strategy was added to Goal 1 in order to encourage federal partnership across all Departmental activities related to homelessness.  Strategy 1.6 reads as follows: “Explore opportunities with federal partners to develop joint initiatives related to homelessness and improve communication on programmatic goals, policies, and issues related to homelessness.”

Strategies in the plan were also revised to reflect the second phase of the Homeless Policy Academies.  This PolicyAcademyfollow-up includes providing technical assistance to the states and territories around effective implementation of their Action Plans and sustaining their momentum in addressing homelessness in their respective states and territories.  In general, the strategies under Goal 2 (to empower our state and community partners to improve their response to individuals and families experiencing homelessness) are related to this second phase of the Homeless Policy Academies.

Finally, disasters are considered as an issue relevant to homelessness, given the devastation caused by Hurricanes Katrina and Rita, and the consequences to those who lost their homes and those who already were homeless before the catastrophe.  To this end, a new strategy in the Plan specifically refers to working with state, local and tribal organizations around policies pertaining to homelessness, including addressing homelessness as a result of disasters, the needs of homeless persons before/during/and after a disaster, and ways to assist the new population of temporarily homeless persons due to a disaster.

Progress Made Since 2003

The strategic action plan developed in 2003 has served as the framework for developing and implementing activities across the Department related to chronic homelessness.  The general premise of the strategic action plan posits that homelessness is a complex social problem, and ending chronic homelessness requires housing combined with the types of services supported by the programs funded and operated by HHS.  The goals outlined within the strategic action plan provided a course of action for the Department to follow in order to improve access to needed health and social services for individuals experiencing chronic homelessness, empower states to improve their response to individuals experiencing chronic homelessness, and to prevent future episodes of homelessness within HHS clientele.  Since 2003, the Department has worked in partnership with the states, other federal Departments, and the U.S. Interagency Council on Homelessness to advance the goals outlined in the strategic action plan. 

In considering the direction of the 2007 Strategic Action Plan, two documents in particular were reviewed carefully: the final report of the National Learning Meeting and the activities matrix of the Secretary’s Work Group.  The National Learning Meeting, held in October of 2005, was the capstone meeting of the first seven Homeless Policy Academies.  Representatives of fifty-four states and U.S. territories joined federal agency partners, public and private organizations addressing homelessness, and technical assistance providers to showcase innovative approaches that states and territories are implementing, exchange peer-to-peer technical assistance, and renew the states and territories commitment to fully implementing their Homeless Policy Academy action plans.  The recommendations of the states and territories were captured in the final report of the meeting and were considered carefully when developing the revised goals and strategies of the 2007 Plan.  The second document that was reviewed was the activities matrix developed by the Secretary’s Work Group on Ending Chronic Homelessness.  The matrix provides the means by which the agencies and staff divisions within the Department track progress towards achieving the goals outlined in the Plan.  By reviewing the activities matrix, the Department can identify where opportunities to move forward exist.   

There are two key areas in which the Department can track its progress since 2003: 1) the programs that serve persons experiencing homelessness and 2) the range of research and programmatic activities that have been undertaken since 2003.  

HHS Programs That Serve Individuals, Youth, and Families Experiencing Homelessness

HHS operates a range of programs that may serve individuals and families experiencing homelessness.  The relevant programs are divided into two categories: targeted homeless assistance programs, which are specifically designed to serve individuals and families who are homeless, and mainstream programs, which are designed to meet broader goals, such as alleviating poverty or providing health care to low-income persons.  The budgets of the targeted homeless programs have experienced growth since 2003 (see Table 1), but improving access to mainstream programs remains critical to increasing the Department’s capacity to serve this population.

Often times, individuals or families who are homeless are eligible for, or can access, services provided through mainstream programs.  The combined total budget of the targeted homeless assistance programs is less than one percent of the combined total budget of the mainstream programs that individuals or families who are homeless may access (see Table 2).  Additionally, utilization of the mainstream programs not only represents a significant funding stream, but also greatly expands the capacity of the Department to provide the necessary services to persons experiencing homelessness.  However, barriers to accessing mainstream programs often hinder the engagement of some persons experiencing homelessness (such as a lack of a permanent, fixed address), and a lack of knowledge about engaging persons experiencing homelessness commonly exists within the broader mainstream service provider community.  In order to improve the accessibility and take advantage of the funding and capacity available within the mainstream programs, the Department has engaged in a range of strategies to increase access to mainstream resources for persons experiencing homelessness.       

Table 2. HHS Budget Growth- Targeted Homelessness Programs FY 2003-FY2006

(all values in millions)

Note: Table reports funding only for targeted homeless programs and does not include funding for research (NIH, OASPE, SAMHSA, HRSA, ACF); *Includes $4 million in one-time CMHS funds to support competitively-awarded supplements for chronic homelessness; ** The Title V/Surplus Property program involves the transfer of surplus federal property from HHS to a homeless assistance provider, and the program does not have a line item budget.

Table 3. HHS Budget Growth- Mainstream Programs FY 2003-FY 2006

Key Research and Programmatic Activities Between 2003 - 2006

Between 2003 and 2007, the Department made significant progress towards the goals identified in the 2003 Plan.  Reviewing key research and programmatic activities accomplished under each of the three original goals of the strategic action plan provide an opportunity to measure the progress of the Department in a quantitative manner and provide context for the revisions that are ultimately laid forth in the 2007 Strategic Action Plan.  

2003 Strategic Action Plan Goal 1:  Help eligible, chronically homeless individuals receive health and social services

The objective of goal one was to expand the capacity of HHS programs to assist persons experiencing chronic homelessness.  Many HHS programs lack the funding to serve individuals with multiple, complex needs.  If the funding is available, effective service delivery interventions may not be applied when working with this population.  The activities developed to meet this goal centered on strengthening outreach and engagement activities, improving the eligibility review process, exploring way to maintain program eligibility, and improving the transition of clients from targeted homeless programs to mainstream service providers.  

• Collaborative Initiative to Help End Chronic Homelessness :   Between2003 and 2005, HHS partnered with the HUD, VA, and USICH to sponsor the Collaborative Initiative to Help End Chronic Homelessness.  Funds from HHS’ Substance Abuse and Mental Health Services Administration (SAMHSA) and Health Resources and Services Administration (HRSA), are helping to support eleven communities that are working to integrate housing and treatment services for disabled persons who have experienced long-term and repeated homelessness.  HHS contributed $10 million to the initial $35 million in funding in 2003, and an additional $10 million each in both fiscal years 2004 and 2005 for these projects.  An additional $1 million has been made available within HHS in order to provide technical assistance to the grantees.  An evaluation of the initiative is also being sponsored by HHS, HUD, and VA; with HHS contributing a total of $600,000 towards the evaluation project.    
• Supplemental Security Income and Social Security Disability Insurance Outreach, Access and Recovery (SOAR):  In 2003, SAMHSA, in consultation with the Social Security Administration, published a volume entitled: Stepping Stones to Recovery,A Case Manager's Manual for Assisting Adults who are Homeless, with Social Security Disability and Supplemental Security Income Applications . This volume is designed to provide an overview of the Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) programs, and to provide frontline caseworkers with the tools to assist persons experiencing homelessness to apply for SSA disability programs. 
• Supplemental Security Income and Social Security Disability Insurance Outreach, Access and Recovery (SOAR) Technical Assistance Initiative :  This training initiative utilizes SAMHSA’s Stepping Stones for Recovery curriculum, with the goal of providing states and local community providers with the tools to implement a specific set of action steps that will lead to increased access to SSA disability benefits for people who are chronically homeless.  Participating states receive in-state facilitation to devise a plan that identifies the staff, training, and interagency coordination needed to increase such access, learn how to use the curriculum and receive follow-up technical assistance, including training for two or more trainers per state to create on-going local training capacity.  SOAR training has been funded through the pooled resources of the funders of the Homeless Policy Academies: HHS, HUD, DOL, and VA.  Since 2005, 25 states have participated in the SOAR training initiative. 
• Documenting Disability: Simple Strategies for Medical Providers :  HRSA sponsored the development of this manual, which is a guide to documenting medical impairments in support of applications for the Social Security Administration’s disability benefits programs.  It is primarily for health care providers in the United States serving individuals with disabilities who are homeless or marginally housed.  The purpose of the manual is to inform clinicians about SSA’s disability criteria and to explain how they can expedite the disability determination process.  By understanding the process of applying for SSA disability benefits and the requirements for providing evidence in support of a disability claim, providers can do so more efficiently and effectively.      
• Evaluation of Housing Approaches for Persons with Serious Mental Illnesses :  SAMHSA sponsored a project to identify models of housing for adults with serious mental illnesses and co-occurring substance abuse disorders that may reduce homelessness and institutionalization and promote community living.  The study evaluated a cross-site evaluation on six sites using a common data collection protocol and site-specific evaluations, with the goal of developing a supportive housing tool kit.  The Supportive Housing Implementation Resource Kit is under development and will be piloted in 2007.
• Funding Health, Behavioral Health, and Support Services for Persons Who Are Homeless with Medicaid :  CMS is developing a primer for policy makers and others who wish to understand what medical, behavioral health, and support services can be reimbursed by Medicaid that would benefit individuals who are homeless.  This report will address an important knowledge gap identified by states, providers, consumers and consultants and is due to be published in 2007.
• Health Care for the Homeless/Community Mental Health Center Collaboration Project:   Between 2002 and 2005, HRSA and SAMHSA funded a demonstration project to expand access to health and behavioral health services for homeless persons with psychiatric and substance use disorders.  Twelve program sites funded with $3.1 million annual funding.  Additional funding was provided by SAMHSA and ASPE to support an evaluation of the demonstration project, and the final evaluation is expected in 2007.
• Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and/or Co-Occurring Substance Abuse Disorders:  In 2003, SAMHSA developed a report designed to help states and local communities develop integrated systems of care to address homelessness among people who have serious mental illnesses and/or co-occurring substance abuse disorders.
• How States Can Use SAMHSA Block Grants to Support Services for People Who are Homeless:  In 2003, SAMHSA published a report to highlight efforts of many states to use the federal block grant funds for mental health and substance abuse services to provide more effective care for people who are homeless.
• Medicare Prescription Drug Coverage and Persons Experiencing Homelessness:  In 2005/2006, the Centers for Medicare and Medicaid Services developed a flyer entitled “What do I need to know about Medicare prescription drug coverage to help my homeless clients?” and circulated the material widely to homeless assistance providers.  
• Benefits for individuals leaving institutional settings :  In 2004, HHS issued policy guidance to encourage states to “suspend” and not “terminate” Medicaid benefits while an individual is in an institutional setting. 
• National Institutes of Health (NIH) Research Initiatives:  Since 2002, the National Institute of Mental Health (NIMH), the National Institute on Drug Abuse (NIDA), and the National Institute on Alcohol Abuse and Alcoholism (NIAAA) have jointly issued a program announcement to support research on homelessness and to develop further knowledge and evidence-based practices for treating and preventing the development of chronic homelessness in vulnerable populations.  A number of research projects have been or are currently supported via this mechanism.

2003 Strategic Action PlanGoal 2:  Empower our state and community partners to improve their response to people experiencing chronic homelessness

HHS is the largest grant-making agency in the federal government and the nation's largest health insurer.  HHS administers more grant dollars than all other federal agencies combined and handles more than one billion insurance claims per year.  These activities are administered by eleven Operating Divisions across the Department.  The Operating Divisions work closely with state, local, and tribal governments, as many HHS-funded services are provided at the local level by state, county or tribal agencies, or through private sector and faith-based grantees.  Much of the funding awarded by HHS is distributed in the form of block grants to states, allowing states to prioritize and direct the funding towards the needs they have prioritized, which may be different than their neighboring states.  As such, it is critical that HHS works with states and community partners to empower them and provide the appropriate tools by which to improve their response to people experiencing chronic homelessness.

• Homeless Policy Academies : Between 2002 and 2005, HHS played a lead role in the development and implementation of nine Homeless Policy Academies designed to improve access to mainstream services for chronically homeless individuals and families with children experiencing homelessness.  The Policy Academies were designed to bring together state-level program administrators and homeless service providers in order to develop state-specific action plans designed to increase access to mainstream resources for persons experiencing homelessness.  To date every state and U.S. Territory and the District of Columbia has participated in a Homeless Policy Academy.  Over the course of three years, nine Policy Academies have been sponsored by HHS, HUD, VA, DOL, Department of Education, Department of Justice, Department of Agriculture, and the U.S. Interagency Council on Homelessness.
• Follow-up Policy Academy Technical Assistance :  Customized technical assistance for the states who have attended a Homeless Policy Academy is a critical component of the Policy Academy activity.  Each state and territory has been provided with a technical assistance budget, and those funds can be used to support a range of technical assistance activities that enable the state to implement their action plans.  Funds from multiple contracts have been woven together to provide this technical assistance, and HHS is partnering with the other sponsoring federal agencies to fund technical assistance to all state and territories developing and implementing state action plans that were initiated by attending a Homeless Policy Academy.  Technical assistance has been delivered since 2003 and will continue into 2007.
• Learning Community Workgroups :  In 2006, HHS partnered with other federal agencies to develop and implement a series of Learning Communities Workgroups, which were small meetings gathering representatives form ten to twelve states to focus on specific topic areas to help move states along in their implementation of their state plans drafted through the policy academy process.  Four Learning Community Workgroups were held during 2006 on the following topics: youth homelessness, transition/discharge planning, employment, and data and performance measurement.  
• FirstStep, a CD-ROM resource: HHS and HUD jointly developed and disseminated widely FirstStep, an easy-to-use, interactive tool for case managers, outreach workers and others working with people who are homeless.  FirstStep, first released in October 2003, is a CD-ROM resource that staff can use to identify the health services and benefits needed by a homeless person available through mainstream programs, and to determine how to go about accessing these services.  Currently, CMS is making a series of refinements to the FirstStep product to address additional needs articulated by states and other constituents.   The Social Security Administration, the Department of Agriculture, the Department of Labor, and the Department of Veterans Affairs also partnered with HHS and HUD to develop FirstStep.
• Participation of HHS Regional Offices in Regional Interagency Councils on Homelessness:  All ten regions have established regional ICHs or other homelessness committees involving appropriate federal agencies. Several Regional ICHs are working with their states and communities in the development of ten-year plans for ending chronic homelessness.  Other activities include technical assistance workshops for state and local homelessness program coordinators, conferences, resource directories, and working with local governments to identify barriers to accessing services.
• National Training Conference on Homelessness and Mental Illness :  SAMHSA hosts a biennial national training conference addressing homelessness for people with mental illness and/or substance abuse disorders.  The conference typically features three days of interactive workshops on housing, services, and cross-cutting issues, and is attended by roughly 800 clinicians, program officials, and policy makers. 
• National Health Care for the Homeless Conference :  HRSAsponsors an annual National Health Care for the Homeless (HCH) conference.  These conferences, typically attended by 800-900 consumers, providers, and administrators, focus on the clinical, administrative, and policy challenges facing homeless persons and those that serve them.  In addition to the main conference, there are supplemental all-day sessions on timely topic areas.
• National Returning Veterans Conference : The Road Home: National Behavioral Health Conference on Returning Veterans and Their Families:  In March of 2006, SAMHSA sponsored a conference to give federal, state, and local public and private service providers evidence-based information and approaches that can help veterans and their families build resiliency to prevent and to treat mental health disorders (including Post-Traumatic Stress Disorders), substance abuse disorders, suicide, and/or co-occurring disorders. 
• Symposium on Housing for Persons with Disabilities : Understanding Universal Design and Access Modification.  In June 2004, the HHS Office on Disability partnered with CMS, HUD, Fannie Mae and North Carolina State University to host a Symposium on housing for persons with disabilities.  The focus of this Symposium was on universal design and access modification for persons with disabilities; including those with physical, visual, hearing, cognitive, and mental disabilities.  A webcast of the Symposium, as well as a webcast for a prior Symposium on home ownership are both available online at http://www.hhs.gov/od/archive_webcasts.html

2003 Strategic Action PlanGoal 3:  Work to prevent new episodes of homelessness within the HHS clientele

Prevention activities are critical to any plan that seeks to end chronic homelessness.  However, in order to prevent homelessness, we first need to understand effective prevention interventions.  As such, HHS has sponsored research over the past several years to better understand what prevention models might be effective.

• Evaluability Assessment of Discharge Planning to Prevent Homelessness :  ASPE sponsoredanevaluability assessment of discharge planning in institutional and custodial settings, with a specific focus on whether discharge planning is a strategy that can prevent homelessness.  The project included a literature review on discharge planning; a documentary analysis of selected exemplary programs, including site visits to identified programs; and a final report that summarizes key findings from the study, including possible evaluation design options.  The final report was published September 2005 and available at: http://aspe.hhs.gov/hsp/05/discharge-planning/index.htm
• Characteristics and Dynamics of Homeless Families with Children : Recognizing that data on homeless families is not as robust as data available on single adults, ASPE is sponsoring a research project designed to identify opportunities and strategies to improve data about homeless families upon which future policy and program decisions may be based by investigating the availability of data with which to construct a typology of homeless families.  A typology could foster a better understanding of these families’ characteristics, service needs, interactions with human services systems, and the dynamics of their use of emergency shelter and other services and assistance.  The final report from this project will be available in the spring of 2007.
• Evaluation of Chronic Homelessness Policy Academies : HRSA is partnering with SAMHSA/CMHS to co-fund an evaluation of the Chronic Homelessness Policy Academies, a multi-year project that was funded by HHS, HUD, VA, and DOL.  The Homeless Policy Academies were designed to offer states an opportunity to bring together a team of policy-makers, providers, and program leaders to spend three days working on a strategic action plan to increase access to mainstream services for people experiencing chronic homelessness.  Both a process evaluation and an outcome evaluation will document the process, assess the effectiveness of the Academies, and identify lessons learned from the Policy Academy activity for the 49 states and territories who attended a chronic homeless Academy.  Final evaluation report is expected in late 2007.
• National Symposium on Homelessness Research : ASPE is partnering with HUD to sponsor a National Symposium on Homelessness Research.  This project will oversee the commissioning of a series of synthesis papers, the organization of a symposium to present and discuss the papers, and the production of a final report featuring the papers commissioned for the project.  Over the past decade, the landscape of homelessness research has evolved immensely; new models for housing and service delivery have emerged and cutting edge research has expanded our understanding of the various populations that experience homelessness.  The findings presented through this project will serve to guide federal and state policymaking, to assist local practitioners in incorporating successful strategies into their programs, and to assist researchers to identify areas meriting future research.  The Symposium will be held in 2007 and the volume of final papers will also be available in 2007.         
• Homeless Families Program :  SAMHSA funded a multi-site study of the effectiveness of services provided to homeless women and their children.  Approximately 1600 women and their families received services under this program.  The project was designed to document and evaluate the effectiveness of time-limited, intensive intervention strategies for providing treatment, housing, support, and family preservation services to homeless mothers with psychiatric and/or substance use disorders who are caring for their dependent children.  The study design involved a five-year, cross-site data collection and analysis program involving eight study sites.  The project was begun in September of 1999 and data collection was concluded in September of 2006.  A series of articles that report the study findings will be published in the Journal of Community Psychology in 2007.
• Promising Strategies to End Youth Homelessness : The Family and Youth Services Bureau within ACF, in consultation with the USICH, is conducting a study of "promising strategies to end youth homelessness" which responds to statutory requirements.  The study will identify and assess a wide range of practices that show promise or carry evidence of effectiveness in helping young people find appropriate living situations, including those youth who have suffered from systemic failures, such as when child welfare and juvenile justice programs have been incapable of providing effective transitions to adult independence for youth in their care.  Runaway and homeless youth served by FYSB are served in emergency situations and cases where returning home is not an option.  The study is anticipated to be released in 2007.    

Bassuk, Ellen L., Buckner, John C., Weinreb, Linda F., Browne, Angle, et al.  Homelessness in Female-Headed Families: Childhood and Adult Risk Protective Factors.  American Journal of Public Health. 1997; 87(2): 241-248.

Bassuk, Ellen L., Weinreb, Linda F., Buckner, John C., Browne, Angela; et al.  The Characteristics and Needs of Sheltered Homeless and Low-Income Housed Mothers.  JAMA. 1996; 276(8): 640-646.

Burt, M., Aron, L.Y., Douglas, T., Valente, J., Lee, E., & Iwen, B.  (Urban Institute) (1999).  Homelessness: Programs and the people they serve:  Findings of the National Survey of Homeless Assistance Providers and Clients : Technical report prepared for the Interagency Council on Homelessness.  Washington, D.C.:  The Council. 

Farrow, J.A., Deisher, R.W., Brown, R., Kulig, J.W., and Kipke, M.D.  Health and health needs of homeless and runaway youth.  A position paper of the Society for Adolescent Medicine.  Journal of Adolescent Health. 1992; 13(8): 717-726.

Helping America's Homeless: Emergency Shelter or Affordable Housing? by Martha Burt, Laudan Y. Aron and Edgar Lee (with Jesse Valente); Washington, DC: The Urban Institute Press; 2001.

Koegel, Paul, Elan Melamid, and M. Audrey Burnam.  Childhood risk factors for homelessness among homeless adults.  American Journal for Public Health . 1995; 85(12): 1642-1649.    

Kuhn R, Culhane DP.  Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: results from the analysis of administrative data.  AmericanJournal of Community Psychology. 1998; 26(2): 207-232.  

Metraux, Stephen, Dennis P. Culhane, Stacy Raphael, Matthew White, Carol Pearson, Eric Hirsch, Patricia Ferrell, Steve Rice, Barbara Ritter, & J. Stephen Cleghorn. Assessing Homeless Population Size through the Use of Emergency and Transitional Shelter Services in 1998: Results from the Analysis of Administrative Data in Nine US Jurisdictions. Public Health Reports.  2001; 116: 344-352.

Park, Jung Min, Metraux, Stephen, Brodbar, Gabriel, and Culhane, Dennis P., Child welfare involvement among children in homeless families.  Child Welfare. 2004; 83(5): 423-436.

Ringwalt, C.L., Greene, J.M., Robertson, M; McPheeters. (1998). The prevalence of homelessness among adolescents in the United States.  AmericanJournal of Public Health. 1998; 88(9): 1325-1329.

Robertson, M.J., & Toro, P.A 1999. Homeless Youth: Research, Intervention, and Policy.  Practical Lessons: The 1998 National Symposium on Homelessness Research .  Washington DC. U.S. Departments of Housing and Urban Development and Health and Human Services.

Shinn, Marybeth, Weitzman, Beth C., Stojanovic, Daniela, Knickman, James R., et al.  Predictors of Homelessness Among Families in New York City: From Shelter Request to Housing Stability.  American Journal of Public Health ; 1998; 88(11): 1651-1657.

United States Conference of Mayors.  A Status Report on Hunger and Homelessness in America’s Cities: A 23-City Survey, December 2006, available on-line at: http://www.mayors.org/uscm/hungersurvey/2006/report06.pdf.

Webb, David A., Culhane, Jennifer, Metraux, Stephen, Robbins, Jessica, and Culhane, Dennis.  Prevalence of episodic homelessness among adult childbearing women in Philadelphia, PA.   American Journal of Public Health. 2003; 93(11): 1895-1896.  

Appendix A: Overview of Programs Operated by the U.S. Department of Health and Human Services That May Serve Persons Experiencing Homelessness

HHS identifies 18 targeted and non-targeted programs as relevant to serving eligible homeless persons.  The targeted programs are much smaller in scope, but are designed specifically for individuals or families who are experiencing homelessness.  Mainstream programs are designed to serve those who meet a set of eligibility criteria that is often established by the states, but generally address provision of services to low-income populations.  Very often, persons experiencing homelessness may be eligible for services funded through these programs.  These programs are located in five of the organizational components of HHS and their role in serving persons experiencing homelessness are detailed in this Appendix.

HHS Targeted Homelessness Programs

Grants for the Benefit of Homeless Individuals (GBHI) (also referred to as Treatment for Homeless)

The Grants for the Benefit of Homeless Individuals(GBHI) program enables communities to expand and strengthen their treatment services for homeless individuals with substance abuse disorders, mental illness, or with co-occurring substance abuse disorders and mental illness.  Eligible applicants are community-based public and private nonprofit entities.  Since the inception of the Treatment for Homeless program, over 10,000 persons have received grant-supported services.  As of October 2006, there were 91 active GBHI grants.  

Programs and activities include: (1) substance abuse treatment; (2) mental health services; (3) immediate entry to treatment; (4) wrap-around services; (5) outreach services; (6) screening and diagnostic treatment services; (7) staff training; (8) case management services; (9) supportive and supervisory services in outpatient and residential settings; and (10) referrals for primary health services, job training, educational services, and relevant housing services.

Funds may not be used to: (1) pay for housing (other than residential substance abuse treatment and/or residential mental health programs); (2) carry out syringe exchange programs; and (3) pay for pharmacologies for HIV antiretroviral therapy, STDs, TB and hepatitis B and C services. 

Health Care for the Homeless (HCH)

The purpose of the Health Care for the Homeless (HCH) program operated by the Health Resources and Services Administration (HRSA) is to provide primary health care, substance abuse treatment, emergency care with referrals to hospitals for in-patient care services and/or other needed services, and outreach services to assist difficult-to-reach homeless persons in accessing care, and provide assistance in establishing eligibility for entitlement programs and housing.                                

Eligible grant recipients include private nonprofit and public entities.  Eligible recipients of services include persons who are literally homeless, as well as those who are living in transitional housing arrangements.  Services provided include primary health care, substance abuse, mental health, and oral health services; extensive outreach and engagement; extensive case management services; and assistance with accessing public benefits, housing, job training, etc.  HCH works within guidelines for the Community Health Center (Health Center) program.  Health centers serve all residents in their catchment area, regardless of ability to pay.  Health Centers serve homeless individuals as appropriate, therefore, Centers located in communities that do not have HCH programs may serve persons who are homeless.  Approximately 650,000 persons are served annually by HCH program grantees.

Projects for Assistance in Transition from Homelessness (PATH)

PATH is a formula grant program operated by the Substance Abuse and Mental Health Services Administration (SAMHSA) to provide financial assistance to states to support services for homeless individuals who have serious mental illness or serious mental illness and substance abuse.  The formula allots funds on the basis of the population living in urbanized areas of the state, compared to the population living in urbanized areas of the entire United States, except that no state receives less than $300,000 ($50,000 for territories).  States must agree to make available nonfederal contributions equal to not less than $1 (in cash or in kind) for each $3 of Federal funds provided in such grant.  Territories have no matching requirements.  Not more than 20 percent of the payment may be expended for housing services.

Eligible programs and activities include: (1) outreach services; (2) screening and diagnostic treatment services; (3) habilitation and rehabilitation services; (4) community mental health services; (5) alcohol or drug treatment services; (6) staff training; (7) case management services; (8) supportive and supervisory services in residential settings; (9) referrals for primary health services, job training, educational services, and relevant housing services; and (10) a prescribed set of housing services.

According to the latest available data, state-funded community based agencies used FY 2003 allocations to provide PATH eligible services to 86,000 enrolled persons.  Persons served were among the most severely disabled.  Thirty-six percent of clients had schizophrenia and other psychotic disorders; 59% of persons served had a co-occurring substance use disorder in addition to a serious mental illness; and almost 69% of clients served were living on the street or in emergency shelters. 

Programs for Runaway and Homeless Youth (RHY)

The Administration for Children and Families (ACF) funds 669 public, community and faith-based programs through three grant programs that serve the runaway and homeless youth population.  Ninety percent of grant dollars awarded are used for preventive activities, and/or housing activities for youth who are at-risk of experiencing homelessness or are already in a homeless situation, and ten percent of funds are used for support services.

Eligible applicants for the Basic Center and Transitional Living Programs are states, units of local government, a combination of units of local government, and public or private nonprofit agencies, organizations or institutions.  Federally recognized Indian Tribes, Indian Tribes that are not federally recognized and urban Indian organizations are also eligible.  Eligible applicants for the Street Outreach Program include any private, nonprofit agency, non-federally recognized Indian Tribes and urban Indian organizations. 

BasicCenterProgram

The purpose of the Basic Center Program is to establish or strengthen locally-controlled, community and faith-based programs that address the immediate needs of runaway and homeless youth and their families.  Basic Centers provide youth with temporary emergency shelter, food, clothing, and referrals for health care.  Other types of assistance provided to youth and their families may include individual, group, and family counseling; recreation programs; and aftercare services for youth once they leave the shelter.  Grants can also be used for outreach activities targeting youth who may need assistance.  Basic Centers seek to reunite young people with their families when possible, or to locate appropriate alternative placements.

Transitional Living Program

The purpose of the Transitional Living Program is to provide shelter, skills training, and support services to youth, ages 16 through 21, who are homeless, for a continuous period, generally not exceeding 18 months.  Youth who have not reached the age of 18 years during an 18 month stay may remain in the program for an additional 180 days or until their 18 th birthday, whichever comes first.

Youth are provided with stable, safe living accommodations and services that help them develop the skills necessary to move to independence.  Living accommodations may be host family homes, group homes, including maternity group homes, or “supervised apartments.”  Skills training and support services provided include: basic life-skills and interpersonal skill building; educational opportunities (vocational and GED preparation); job placement; career counseling; and mental health, substance abuse, and physical health care services.

Street Outreach Program

The purpose of the Street Outreach Program is to provide educational and prevention services to runaway, homeless and street youth who have been subject to, or are at risk of, sexual exploitation or abuse.  The program works to establish and build relationships between street youth and program outreach staff in order to help youth leave the streets.  Support services that will assist the youth in moving and adjusting to a safe and appropriate alternative living arrangement include:treatment, counseling, information and referral services, individual assessment, crisis intervention, and follow up support.

Street outreach programs must have access to local emergency shelter space that is an appropriate placement for young people and that can be made available for youth willing to come in off the streets. 

Title V Surplus Property Program

Title V of the McKinney-Vento Homeless Assistance Act (Title V),authorizes the Secretary of Health and Human Services to make suitable federal properties categorized as excess or surplus available to representatives of persons experiencing homelessness as a permissible use in the protection of public health.  The purpose of the program is to provide federal surplus land and buildings to organizations which serve the needs of the homeless.  Eligible applicants are states and their political subdivisions and instrumentalities, and tax-supported and nonprofit institutions, which provide a broad array of services to the homeless.  Eligible activities include emergency and transitional housing and related services; substance abuse and mental health programs for homeless individuals; homeless ex-offender aftercare programs and miscellaneous other supportive homeless services.  A policy change that took effect in September of 2006 expands the allowable uses of surplus real property to include permanent supportive housing.  Currently, there are 80 active properties on which numerous services are provided to homeless individuals and/or families.  There are approximately 3,000 transitional housing beds and 800+ emergency housing beds being successfully operated by homeless assistance providers receiving properties pursuant to Title V of the McKinney-Vento Homeless Assistance Act.

HHS Mainstream Programs

Access to Recovery (ATR)

Access to Recovery (ATR), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA) and established in 2003, supports a grantee-run voucher program for substance abuse clinical treatment and recovery support services built on the following three principles: consumer choice, outcome oriented, and increased capacity.  ATR is a competitive grant program, and selected ATR Grantees have designed their approach and targeted efforts to areas of greatest need, areas with a high degree of readiness, and to specific populations, including adolescents.  Critically, grantees are using the new funds to supplement, not supplant current funding and are building on existing programs.  The goal of the program is to expand clinical treatment and recovery support services to reach those in need.  

Child Support Enforcement Program

The mission of the child support enforcement program is to assure that assistance in obtaining support (both financial and medical) is available to children through locating parents, establishing paternity and support obligations, and enforcing those obligations.  The program is a federal/state/tribal/local partnership to help families by promoting family self-sufficiency and child well-being.  All States and territories run a child support enforcement program, usually in the human services department, department of revenue, or the State Attorney General’s office, often with the help of prosecuting attorneys, district attorneys, other law enforcement agencies and officials of family or domestic relations courts.  Native American Tribes, too, can operate culturally appropriate child support programs with Federal funding.   Families seeking government child support services must apply directly through their state/local agency or one of the tribes running the program.   Services are available to a parent with custody of a child whose other parent is living outside the home, and services are available automatically for families receiving assistance under the Temporary Assistance for Needy Families (TANF) program.

The child support program in each state can be a helpful resource to families consisting of single custodial parents with children, since a reason for the homelessness may be non-payment of child support.  In addition, child support programs can help homeless noncustodial parents, through outreach, address any outstanding child support issues (perhaps helping them with the order modification process) and connecting them with organizations that can help them with basic skills, such as how to seek and maintain employment, and understand issues surrounding court and child support agency processes.

Community Mental Health Services Block Grant (CMHSBG)

The Community Mental Health Services Block Grant(CMHSBG), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), is a formula grant to states and territories for providing mental health services to people with serious mental illnesses.  The formula for determining the federal allocations of funds to the states is determined by Congress.  The funds are intended to improve access to community-based health care delivery systems for adults with serious mental illnesses and children with serious emotional disturbances.  States design a services delivery plan that addresses the unique needs of the state's populations.  Mental health plans must respond to federal criteria that include: 1) a comprehensive community based mental health system with a description of health and mental health services, rehabilitation services, employment services, housing services, educational services, substance abuse services, medical and dental care; 2) mental health system data and epidemiology estimates of incidence and prevalence in the state of serious mental illness among adults and serious emotional disturbance among children; 3) services for children with serious emotional disturbance provided in an integrated system of care; 4) targeted services to rural and homeless populations with a description of state’s outreach to and services for individuals who are homeless and how community-based services will be provided to individuals residing in rural areas; and 5) management systems for financial resources, staffing and training for mental health providers, and training of providers of emergency health services.  CMHSBG funds are used to carry out the plan, evaluate programs and services carried out under the plan, and for planning, administration and educational activities that relate to providing services under the plan.  Block grant funds are used by each state as they determine their needs; therefore, the program does not require states to report on expenditures related to homelessness. 

Community Services Block Grant (CSBG)

The purpose of the Community Services Block Grant (CSBG) operated by the Administration for Children and Families (ACF) is to provide services and activities to reduce poverty, including services to address employment, education, better use of available income, housing assistance, nutrition, energy, emergency services, health, and substance abuse needs.  Funds are allocated by formula to 50 states and the District of Columbia, Puerto Rico, Guam, American Samoa, the Virgin Islands, the Northern Marianas, and state and federally-recognized Indian tribes.  Funds are used by states to support a network of local community action agencies, federally and state recognized Indian tribes and tribal organizations, migrant and seasonal farm worker organizations, or private/public community-based organizations to provide a range of services and activities to assist low-income individuals, and families, including the homeless, to alleviate the causes and conditions of poverty.  As a flexible block grant awarded to states and U.S. Territories, CSBG does not collect specific data on amounts expended on homelessness.   

Community Health Centers (CHC)

The Community Health Centers, operated by the Health Resources and Services Administration (HRSA),provide health services to underserved populations.  This includes people who face barriers in accessing services because they have difficulty paying for services, have language or cultural differences, or because there is an insufficient number of health professionals/resources available in their community.  Health Centers provide health care services as described in statute and regulation.  They provide basic preventive and primary health care services.  Health Centers also provide services that help ensure access to the primary care such as case management, outreach, transportation and interpretive services.  Services are provided without regard for a person’s ability to pay.  Fees are discounted or adjusted based upon the patient’s income and family size from current Federal Poverty Guidelines.  All grantees must demonstrate that all persons will have access to the full range of required primary, preventive, enabling, and supplemental health services, including oral health care, mental health care and substance abuse services, either directly on-site or through established arrangements.  In FY 2006, the entire Health Center program, including HCH, received $1.785 billion (including funds for Tort Claims).  Health Center reporting does not support an estimate of expenditures on homelessness outside of the HCH program. 

Family Violence Prevention and Services Grant Program (FVPS)

The purpose of the Family Violence Prevention and Services program, operated by the Administration for Children and Families, is to fund grants to state agencies, territories and Indian Tribes for the provision of shelter to victims of family violence and their dependents, and for related services, such as emergency transportation and child care. Grantees use additional resources to expand current service programs and to establish additional services in rural and underserved areas, on Native American reservations, and in Alaskan Native Villages.  The program also supports technical assistance and training for local domestic violence programs and disseminates research and information through five resource centers.

Head Start and Early Head Start are comprehensive child development programs operated by the Administration for Children and Families (ACF) that serve children from birth to age five, pregnant women, and their families.  It is a child-focused program with the overall goal of increasing the school readiness of young children in low-income families.  Head Start serves homeless families eligible for the program in areas such as nutrition, developmental, medical and dental screenings, immunizations, mental health and social services referrals, and transportation.  Section 645 of the 1998 Head Start Act establishes income eligibility for participation in Head Start programs by reference to the official poverty line, adjusted annually in accordance with changes in the Consumer Price Index.  Homeless families often fall within these guidelines.  In FY 2005, Head Start served approximately 20,000 homeless children and their families throughout the country at a cost of $143,705,000. 

Maternal and Child Health Services Block Grant (MCHBG)

The Maternal and Child Health Services Block Grant (MCHBG), operated by the Health Resources and Services Administration (HRSA), has three components: formula block grants to 59 states and Territories, grants for Special Projects of Regional and National Significance, and Community Integrated Service Systems grants.  It operates through a partnership with State Maternal and Child Health and Children with Special Health Care Needs programs.  The Program supports direct care; core public health functions such as resource development, capacity and systems building; population-based functions such as public information and education, knowledge development, outreach and program linkage; technical assistance to communities; and provider training.  Most services supported by MCH block grant funds fall within four areas:  1) Direct Health Care - Basic health care services are provided to individual clients generally on a one-on-one basis between health care professionals and patients in a clinic, office, or emergency room; 2) Enabling Services - These services help targeted populations in need to gain access to the care that is available to them.  Types of services include transportation to care, translation services, respite care for family caregivers, and health education programs; 3) Population-based Services - Most of these services are preventive services that are available to everyone.  Examples include immunizations, child injury prevention programs, lead poisoning prevention activities, and newborn screening programs; and 4) InfrastructureBuilding - These activities form the foundation of all MCH-funded services.  Activities include: evaluation, monitoring, planning, policy development, quality assurance, training and research.  Neither HRSA nor states collect financial data on how many of its program dollars support homeless mothers and children, nor does it collect program data that indicates how many homeless mothers and children are served by Title V.

Medicaid, operated by the Centers for Medicare and Medicaid Services (CMS), is a jointly funded, federal-state health insurance program for certain low-income and needy people.  In FY 2005, Medicaid provided coverage to more than 44.7 million individuals including 21.7 children, the aged, blind and/or disabled, and people who are eligible to receive federally assisted income maintenance payment.  Total expenditures for the Medicaid program in FY 2005 were $182 billion, however, state Medicaid programs are not required to report to CMS on the homelessness or housing status of persons who receive health care supported with Medicaid funding; therefore, Medicaid data systems are not designed to produce estimates of expenditures on services provided to persons who are homeless.

Ryan White CARE Act

The Ryan White CARE Act,operated by the Health Resources and Services Administration (HRSA), authorizes funding for the bulk of the agency’s work on HIV/AIDS.  Programs are funded through states, disproportionately impacted metropolitan areas, community health centers, dental schools, and health care programs that target women, infants, youth, and families.  An increasing number of the people accessing HIV/AIDS services and housing have histories of homelessness, mental illness, and chemical dependency.  The HRSA bureau responsible for administration of the CARE Act, the HIV/AIDS Bureau (HAB), has approached the issue of housing and healthcare access through housing policy development, direct service programs, service demonstrations, as well as in technical assistance and training activities to grantees.  According to our CY 2004 CARE Act Data Report (CADR), of the 2,467 providers responding to the question whether they delivered services to special target populations, 1,184 providers indicated that they provided services to persons experiencing homelessness. 

Types of housing assistance provided through the CARE Act:

-- Housing referral services defined as assessment, search, placement, and advocacy services;

-- Short-term or emergency housing defined as necessary to gain or maintain access to medical care;

-- Housing services that include some type of medical or supportive service including, but not limited to residential substance treatment or mental health services, residential foster care, and assisted living residential services (does not include facilities classified as an institute of mental diseases under Medicaid);

-- Housing services that do not provide direct medical or supportive services but are essential for an individual or family to gain or maintain access and compliance with HIV-related medical care and treatment.  Necessity of housing services for purposes of medical care must be certified or documented.

Social Services Block Grant

The Social Services Block Grant (SSBG) operated by the Administration for Children and Families (ACF) assists states in delivering social services directed toward the needs of children and adults.  Funds are allocated to the states on the basis of population.  SSBG funds support outcomes across the human service spectrum, and these outcomes are associated with strategic goals and objectives such as employment, child care, child welfare, adoptions, and youth services.  The SSBG allows states flexibility in their use of funds for a range of services, depending on state and local priorities.  The SSBG is based on two fundamental principles: (1) state and local governments and communities are best able to determine the needs of individuals to help them achieve self-sufficiency; and (2) social and economic needs are interrelated and must be met simultaneously.  States have the flexibility to spend SSBG funds on a variety of services.  Of these, services to promote self-sufficiency are the most relevant to homelessness.  In FY 2004, the most recent data available, states reported spending $111 million on self-sufficiency services, including education/training, employment services, family planning services, independent/transitional living for adults, pregnancy and parenting, and substance abuse services.  As a flexible block grant awarded to states and U.S. Territories, SSBG does not collect specific data on amounts expended on homelessness.   

State Children’s Health Insurance Program (SCHIP)

The State Children’s Health Insurance Program, operated by the Centers for Medicare and Medicaid Services (CMS), is a partnership between the Federal and State Governments that provides health coverage to uninsured children whose families earn too much to qualify for Medicaid, but too little to afford private coverage.  The federal government establishes general guidelines for the administration of SCHIP benefits.  However, specific eligibility requirements to receive SCHIP benefits, as well as the type and scope of services provided, are determined by each state.  Total expenditures for the SCHIP program in FY 2005 were $5.129 billion, however, state SCHIP programs are not required to report to CMS on the homelessness or housing status of persons who receive health care supported with SCHIP funding; therefore, SCHIP data systems are not designed to produce estimates of expenditures on services provided to eligible homeless persons.

State Protection and Advocacy Agencies (P&As)

The Administration for Children and Families oversees a program to support a Protection & Advocacy (P&A) System in each State, Territory, as well as a Native American Consortium, to protect and advocate for persons with developmental disabilities.  All States, Territories, and a Native American Consortium (total of 57) are funded under the Protection & Advocacy for Individuals with Developmental Disabilities (PADD) program that requires the governor to designate a system in the State to empower, protect, and advocate on behalf of persons with developmental disabilities.  The PADD program provides information and referral services and exercises legal, administrative and other remedies to resolve problems for individuals and groups of clients with developmental disabilities.  The PADD program protects the legal and human rights of all persons with developmental disabilities. The amount of funding for the PADD program in an individual State is based on a formula that takes into account the population, the extent of need for services for persons with developmental disabilities, and the financial need of the State.

The PADD program in each State has a significant role in enhancing the quality of life of persons with developmental disabilities in every community. The PADD is mandated to:

• investigate incidents of abuse and neglect, follow up on reports of such incidents, and investigate if there is probable cause to believe that such incidents have occurred; and
• have access to all client records when given permission by the client or the client’s representative authorization and have access records without permission when there is probable cause that abuse or neglect is involved

Substance Abuse Prevention and Treatment Block Grant (SAPTBG)

The Substance Abuse Prevention and Treatment Block Grant (SAPTBG), operated by the Substance Abuse and Mental Health Services Administration (SAMHSA), is a formula block grant to states to provide substance abuse treatment and prevention services to individuals in need.  The formula grant is intended to provide maximum flexibility to states in determining allocations of the block grant to all populations within the states, dependent on state needs and priorities, including vulnerable and underserved populations such as the homeless and those at risk of homelessness. The authorizing legislation does not, however, specify homeless services and current policy does not encourage set-asides for specific populations.  For FY 1999 (the only year for which a special analysis was compiled), the 40 participating states reported just over $26 million SAPTBG funds were spent on alcohol and drug abuse services to homeless populations, approximately 1.64 percent of the Block Grant (Analysis by the National Association of State Alcohol and Drug Abuse Directors [NASADAD], 2002).

Temporary Assistance for Needy Families (TANF)

Temporary Assistance for Needy Families (TANF) is a block grant to states operated by the Administration for Children and Families (ACF).  Title IV-A, section 404 of the Social Security Act (Act) allows states, Territories and federally recognized Indian Tribes to use Federal TANF funds in any manner that is reasonably calculated to accomplish a purpose of the TANF program.  Section 401 of the Act sets forth the following four TANF purposes: (1) provide assistance to needy families so that children may be cared for in their own homes or in the homes of relatives; (2) end the dependence of needy parents on government benefits by promoting job preparation, work, and marriage; (3) prevent and reduce the incidence of out-of-wedlock pregnancies and establish annual numerical goals for preventing and reducing the incidence of these pregnancies; and (4) encourage the formation and maintenance of two-parent families. 

Each state, territory, and participating Tribe decides the benefits it will provide and establishes the specific eligibility criteria that must be met to receive financial assistance payments and/or other types of TANF-funded benefits and services.  TANF agencies provide a range of benefits to eligible families who are homeless or at-risk of becoming homeless.  Common benefits and services provided to homeless families include: cash assistance for temporary shelter arrangements; assistance to obtain permanent housing; case management services; one-time cash payments; and vouchers for food, clothing, and household expenses.  For at-risk families, common benefits include counseling, housing referrals, assistance for past due utility bills, and assistance for arrearages in rent or mortgage payments.  As a flexible block grant to states, states are not required to report data related to homelessness.

Appendix B: U.S. Department of Health and Human Services Resources on Homelessness

HHS Web Resources Relevant to Homelessness

U.S. Department of Health and Human Services Homelessness Website:

http://www.hhs.gov/homeless

U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration Homelessness Website:

http://homeless.samhsa.gov/

U.S. Department of Health and Human Services, Centers for Medicare and Medicaid Services Homelessness Website:

http://www.cms.hhs.gov/HomelessnessInitiative/

Homelessness Policy Academy Website:

http://www.hrsa.gov/homeless

PATH Program Website:

http://pathprogram.samhsa.gov/

National Resource and Training Center on Homelessness and Mental Illness:

http://www.nrchmi.samhsa.gov/

http://www.cms.hhs.gov/apps/firststep/index.html

National Communications System: The National Runaway Switchboard:

http://www.acf.hhs.gov/programs/fysb/content/youthdivision/resources/nrsfactsheet.htm

Runaway and Homeless Youth Management Information System:

http://www.acf.hhs.gov/programs/fysb/content/youthdivision/resources/rhymsfactsheet.htm

Runaway and Homeless Youth Programs:

• Basic Center Program: http://www.acf.hhs.gov/programs/fysb/content/youthdivision/programs/bcpfactsheet.htm
• Transitional Living Program: http://www.acf.hhs.gov/programs/fysb/content/youthdivision/programs/tlpfactsheet.htm
• Street Outreach Program: http://www.acf.hhs.gov/programs/fysb/content/youthdivision/programs/sopfactsheet.htm

Healthcare for the Homeless Information Resource Center:

http://bphc.hrsa.gov/Hchirc/

Title V Surplus Property Program:

http://www.psc.gov/administrative/federalprop/titlev.html

Recent HHS Publications Relevant to Homelessness

National Symposium on Homelessness Research  (ASPE & HUD)

This project will oversee the commissioning of a series of synthesis papers, the organization of a symposium to present and discuss the papers, and the production of a final report featuring the papers commissioned for the project.  The findings presented through this project will serve to guide federal and state policymaking, to assist local practitioners in incorporating successful strategies into their programs, and to assist researchers to identify areas meriting future research.         The final report, which will consist of a collection of 12 research papers, will be available in the summer of 2007.   

Evaluation of Housing Approaches for Persons with Serious Mental Illnesses  (SAMHSA) 

SAMHSA sponsored a project to identify models of housing for adults with serious mental illnesses and co-occurring substance abuse disorders that may reduce homelessness and institutionalization and promote community living.  The study evaluated a cross-site evaluation on six sites using a common data collection protocol and site-specific evaluations, with the goal of developing a supportive housing tool kit.  The Supportive Housing Implementation Resource Kit is under development and will be piloted in 2007.

Evaluation of Chronic Homelessness Policy Academies  (SAMHSA & HRSA)

HRSA is partnering with SAMHSA/CMHS to co-fund an evaluation of the Chronic Homelessness Policy Academies, a multi-year project that was funded by HHS, HUD, VA, and DOL.  The Homeless Policy Academies were designed to offer states an opportunity to bring together a team of policy-makers, providers, and program leaders to spend three days working on a strategic action plan to increase access to mainstream services for people experiencing chronic homelessness.  Both a process evaluation and an outcome evaluation will document the process, assess the effectiveness of the Academies, and identify lessons learned from the Policy Academy activity for the 49 states and territories who attended a chronic homeless Academy.  Final evaluation report is due in late 2007.

Evaluation of the Health Care for the Homeless/Community Mental Health Center Collaboration Project  (ASPE & SAMHSA)

ASPE and SAMHSA have supported a 3-year evaluation of a collaboration between Health Care for the Homeless programs and community mental health agencies. 12 grantees were selected with the goal of increasing the availability of mental health and primary care services for homeless persons with serious mental illnesses and explore new approaches to the provision of comprehensive integrated treatment to these consumers.  Grants ended in 2005, and a draft evaluation report is currently under development and expected in 2007. 

Characteristics and Dynamics of Homeless Families with Children  (ASPE)

Recognizing that data on homeless families is not as robust as data available on single adults, this project aims to identify opportunities and strategies to improve data about homeless families upon which future policy and program decisions may be based by investigating the availability of data with which to construct a typology of homeless families.  A typology could foster a better understanding of these families’ characteristics, service needs, interactions with human services systems, and the dynamics of their use of emergency shelter and other services and assistance.  The final report from this project will be available in the Spring of 2007.

Promising Strategies to End Youth Homelessness  (ACF)

The Family and Youth Services Bureau within ACF, in consultation with the USICH, is conducting a study of "promising strategies to end youth homelessness" which responds to statutory requirements.  The study will identify and assess a wide range of practices that show promise or carry evidence of effectiveness in helping young people find appropriate living situations, including those youth who have suffered from systemic failures, such as when child welfare and juvenile justice programs have been incapable of providing effective transitions to adult independence for youth in their care.  Runaway and homeless youth served by FYSB are served in emergency situations and cases where returning home is not an option.  The study is anticipated to be released in 2007.   

Homeless Families Program  (SAMHSA)

SAMHSA funded a multi-site study of the effectiveness of services provided to homeless women and their children.  Approximately 1600 women and their families received services under this program.  The project was designed to document and evaluate the effectiveness of time-limited, intensive intervention strategies for providing treatment, housing, support, and family preservation services to homeless mothers with psychiatric and/or substance use disorders who are caring for their dependent children.  The study design involved a five-year, cross-site data collection and analysis program involving eight study sites.  The project was begun in September of 1999 and data collection was concluded in September of 2006.  A series of articles that report the study findings will be published in the Journal of Community Psychology in 2007.

Mental Health and Substance Abuse Services for Homeless, Runaway, and Thrown Away Youth  (SAMHSA)

This project will examine the range of programs currently offering services to the population and determining the extent to which these programs adhere to best practices approaches.  A total of 491 organizations operating 780 programs have been identified, and data on these programs will be compiled in a national directory of agencies providing services that will be web accessible.

Evaluation of the Collaborative Initiative to Help End Chronic Homelessness  (ASPE)

ASPE is partnering with HUD and the VA to support an evaluation of the Collaborative Initiative to End Chronic Homelessness, a unique grant program funding 11 sites to develop a comprehensive and integrated community strategy to assist chronically homeless persons to move into stable housing and access a range of support services.  Grant funding from HHS, VA, and HUD provides permanent housing, substance abuse and mental health services, primary care services, and case management services for enrolled clients.  Evaluation will examine both client and system-level outcomes, with data collection concluding in March 2007.  A final report will be available in 2009.

An Evaluation of the Respite Pilot Initiative  (HRSA)

In May 2000, HRSA funded ten Health Care for the Homeless grantees, for up to five years, to enhance their medical respite services for homeless persons.  HRSA also supported a prospective evaluation to 1) document the differing models of respite care delivery being used, and 2) assess the effect of those respite services on the health of homeless persons.  A common database was developed to collect client-level data from each of the pilot projects.  These results will enable the HCH Program to determine the efficacy of respite services and in what configuration they are most appropriate.  Final report was published in March 2006 and is available at: http://www.nhchc.org/Research/RespiteRpt0306.pdf

The DASIS Report: Homeless Admissions to Substance Abuse Treatment: 2004(SAMHSA)

A short report based on the SAMHSA’s Drug and Alcohol Services Information System (DASIS), the primary source of national data on substance abuse treatment. According to SAMHSA's Treatment Episode Data Set (TEDS), more than 175,300 admissions to substance abuse treatment in 2004 were homeless at time of admission. The admissions who were homeless comprised 13% of all admissions for which living arrangements were recorded; an increase from 10% TEDS admissions reported to be homeless in 2000.  Report is available at http://oas.samhsa.gov/2k6/homeless/homeless.pdf

Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS Pocket Guidebook  (HRSA)

This condensed pocket guidebook on adapting clinical guidelines for homeless clients with HIV/AIDS was a project of the HIV/AIDS Bureau Homelessness and Housing Workgroup in revising the original manual, Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS (2003) , developed by the Health Care for the Homeless (HCH) Clinicians’ Network.  The authors were comprised of health and social service providers experienced in the care of homeless individuals with HIV/AIDS.  This Advisory Committee developed recommendations of adaptations to clinical practice guidelines for homeless clients with HIV/AIDS.  The desired purpose of this pocket handbook is to be utilized as a quick and essential resource tool for clinicians, peer workers, and social service providers in hopes that they will routinely adapt their services and foster better outcomes for homeless clients.  The pocket guide was adopted in August 2006, and is available at: ftp://ftp.hrsa.gov/hab/adaptpractice.pdf

Evaluability Assessment of Discharge Planning to Prevent Homelessness  (ASPE) 

Purpose of this study was to conduct an evaluability assessment of discharge planning in institutional and custodial settings, with a specific focus on whether discharge planning is a strategy that can prevent homelessness.  Project included a literature review on discharge planning, the use of an expert panel, documentary analysis of selected exemplary programs, and site visits to exemplary programs.  Final report published September 2005 and available at: http://aspe.hhs.gov/hsp/05/discharge-planning/index.htm

Using Medicaid to Support Working Age Adults with Serious Mental Illness in the Community: A Handbook  (ASPE)

The purpose of this primer is to describe the Medicaid program in the delivery of services to adults with serious mental illnesses; specifically, the primer explains how existing Medicaid options and waivers are used by states to finance a broad range of community services and supports for adults with serious mental illnesses, and to demonstrate what aspects of state-of-the-art community services and supports for this population are funded by Medicaid.  The primer was published in 2005 and is available at: http://aspe.hhs.gov/daltcp/Reports/handbook.pdf

Stepping Stones to Recovery: A Case Managers Manual for Assisting Adults Who Are Homeless, with Social Security Disability and Supplemental Security Income Applications(SAMHSA)

Individuals who are homeless and have mental illnesses often face overwhelming challenges in obtaining disability benefits through the Social Security Administration (SSA).  A complex application system, confusion over eligibility criteria, and lack of a fixed address can all create seemingly insurmountable hurdles.  This manual was designed to assist case managers and other professionals in obtaining critical services for their clients.  The report was published in 2005 and is available at:  http://www.prainc.com/SOAR/training/manual/SteppingStonesMan.pdf

Improving Medicaid Access for People Experiencing Chronic Homelessness: State Examples (CMS)

This technical assistance report developed in 2004 is designed to highlight several state initiatives that increase Medicaid access for people who are chronically homeless.  Report available at:

http://www.cms.hhs.gov/HomelessnessInitiative/Downloads/ImprovingMedicaidAccess.pdf

The DASIS Report: Characteristics of Homeless Female Admissions to Substance Abuse Treatment: 2002 (SAMHSA)

A short report based on the SAMHSA’s Drug and Alcohol Services Information System (DASIS), the primary source of national data on substance abuse treatment. The data in this report is from the Treatment Episode Data Set (TEDS) 2002 Supplemental Data Set on living arrangements of people admitted for substance abuse treatment.  Report available at:

http://oas.samhsa.gov/2k4/femHomeless/femHomeless.pdf

How States Can Use SAMHSA Block Grants to Support Services for People Who Are Homeless  (SAMHSA)

The Mental Health Block Grant provides funds to States to create comprehensive, community-based systems of mental health care. This report highlights efforts of many States to use Federal Block Grant funds for mental health and substance abuse services to provide more effective care for people who are homeless.

http://oas.samhsa.gov/BG_documentation_070809_final_psg.pdf

Blueprint for Change: Ending Chronic Homelessness for Persons with Serious Mental Illnesses and/or Co-Occurring Substance Use Disorders  (SAMHSA)

This report was developed to disseminate state-of-the-art information about ending homelessness for people who have mental or addictive disorders.  The Blueprint offers practical advice for how to plan, organize, and sustain a comprehensive, integrated system of care designed to end homelessness.  http://store.samhsa.gov/shin/content//SMA04-3870/SMA04-3870.pdf

Achieving the Promise: Transforming Mental Health Care in America  (SAMHSA)

In 2002, the President announced the creation of the New Freedom Commission on Mental Health and charged the Commission to study the mental health service delivery system, and to make recommendations that would enable adults with serious mental illnesses and children with serious emotional disturbance to live, work, learn, and participate fully in their communities.   Achieving the Promise is the final report of the New Freedom Commission.

http://www.mentalhealthcommission.gov/reports/FinalReport/toc.html

Adapting Your Practice: Treatment and Recommendations for Homeless Patients with HIV/AIDS  (HRSA)

A clinical guidebook written by clinicians with extensive experience caring for individuals who are homeless and who routinely adapt their medical practice to foster better outcomes for these patients.  This adaptation of clinical practice guidelines for homeless patients was developed by the Health Care for the Homeless Clinicians’ Network with support from the HIV/AIDS Bureau, Health Resources and Services Administration, U.S. Department of Health and Human Services.  Guidebook published in 2003.  Report is available at: http://www.nhchc.org/Publications/HIVguide52703.pdf

Core Performance Indicators for Homeless-Serving Programs Administered by the U.S. Department of Health and Human Services  (ASPE)

This report explores the feasibility of developing a core set of performance measures across four HHS programs that focus on service delivery to homeless persons. The report also explores the extent to which mainstream service-delivery programs supported by HHS, i.e., those not specifically targeted to homelessness, could generate performance measures on the extent to which homeless persons are served and with what effect. 

http://aspe.hhs.gov/hsp/homelessness/perf-ind03/report.pdf

Ending Chronic Homelessness: Strategies for Action  (HHS)

This document was developed in 2003 by the HHS Secretary’s Work Group on Ending Chronic Homelessness to outline a series of goal and strategies that would align the Department’s effort towards the goal of ending chronic homelessness.

http://aspe.hhs.gov/hsp/homelessness/strategies03/index.htm

1996 National Survey of Homeless Assistance Providers and Clients:  A Comparison of Faith-Based and Secular Non-Profit Programs   (ASPE) This study examines data from NSHAPC to determine more thoroughly the role that faith-based programs play in the larger context of homeless assistance. The study has an explicit focus on comparing homeless assistance programs administered by faith-based versus secular non-profit service agencies. It provides a basic but comprehensive picture of the numbers and characteristics of the two types of homeless assistance programs.

http://aspe.hhs.gov/hsp/homelessness/NSHAPC02/index.htm

Housing is Health Care: A Guide to Implementing the HIV/AIDS Bureau (HAB) Ryan White CARE Act Housing Policy (HRSA)

The main purpose of the Guidebook is to provide guidance on funding of housing-related costs under the CARE Act.  The Guide focuses on implementation of HAB Policy 99-02, as issued in 1999 by the Health Resources and Services Administration, HIV/AIDS Bureau, which administers the CARE Act.  The publication was funded by the U.S. Department of Health and Human Services Health Resources and Services Administration, HIV/AIDS Bureau, with John Snow, Inc. and AIDS Housing of Washington.  The guidebook was published in 2001 and can be found at: ftp://ftp.hrsa.gov/hab/housingmanualjune.pdf

The NIH supports a wide range of studies involving homeless populations because of associations between homelessness and many adverse health conditions.  In FY 2005, NIH is supporting more than 65 investigator-initiated studies with a primary focus on homelessness.  These studies are concentrated primarily in five institutes: the National Institute on Drug Abuse (NIDA), the National Institute on Mental Health (NIMH), the National Institute on Alcohol Abuse and Alcoholism (NIAAA), the National Institute on Child Health and Development (NICHD), and the National Institute on Nursing Research (NINR).  Research projects funded via an NIH grant are traditionally published in scientific journals.

Appendix C: Acronym Glossary

The following is a list of acronyms used throughout this report and their meanings.

ADD- Administration on Developmental Disabilities

ACF – Administration for Children and Families

AHIC – American Health Information Community

AoA – Administration on Aging

ASL – Office of the Assistant Secretary for Legislation

ASPE – Office of the Assistant Secretary for Planning and Evaluation  

ASRT – Office of the Assistant Secretary for Resources and Technology

ATR – Access to Recovery

CADR – CARE Act Data Report

CARE ( as in Ryan White CARE Act) – Comprehensive AIDS Resources Emergency

CCHIT – Certification Commission for Healthcare Information Technology

CD-ROM – Compact Disc Read-Only Memory

CFBCI – Center for Faith-Based and Community Initiatives

CHC – Community Health Centers

CHI – Chronic Homelessness Initiative ( also referred to as the Collaborative Initiative to Help End Chronic Homelessness)

CMHC- Community Mental Health Center

CMHS – Center for Mental Health Services

CMHSBG – Community Mental Health Services Block Grant

CMS – Centers for Medicare and Medicaid Services

CSBG – Community Services Block Grant

CY – Calendar Year

DD- Developmental Disability

DOL – U.S. Department of Labor

ED- U.S. Department of Education

EHR – Electronic Health Records

FTE – Full-Time Equivalent

FY – Fiscal Year

FYSB – Family and Youth Services Bureau

GBHI – Grants for the Benefit of Homeless Individuals ( also referred to as Treatment for Homeless)

HAB – HIV/AIDS Bureau

HCH – Health Care for the Homeless

HHS – U.S. Department of Health and Human Services

HISPC – Health Information Security and Privacy Collaboration

HITSP – Health Information Technology Standards Panel

HIV/AIDS – Human Immunodeficiency Virus / Acquired Immunodeficiency Syndrome

HMIS – Homeless Management Information Systems

HOPE – Homeless Outreach Projects and Evaluation

HRSA – Health Resources and Services Administration

HUD – U.S. Department of Housing and Urban Development

ICH – U.S. Interagency Council on Homelessness

IGA – Office of Intergovernmental Affairs

IOS – Immediate Office of the Secretary

MCHBG – Maternal and Child Health Block Grant

MCHS – Maternal and Child Health Services

NIAAA – National Institute on Alcohol Abuse and Alcoholism

NIDA – National Institute on Drug Abuse

NIH – National Institutes of Health

NIMH – National Institute of Mental Health

NREPP – National Registry of Evidence-Based Programs and Practices

NSHAPC - National Survey of Homeless Assistance Providers and Clients

OASPE – see ASPE

OD – Office on Disability

OGC – Office of the General Counsel

OPDIV – Operating Division

P&A – Protection & Advocacy  

PADD- Protection & Advocacy for Individuals with Developmental Disabilities

PART – Program Assessment Rating Tool

PATH – Projects for Assistance in Transition from Homelessness

PSC – Program Support Center

PTSD – Post-Traumatic Stress Disorder

RHY – Programs for Runaway and Homeless Youth

SAMHSA – Substance Abuse and Mental Health Services Administration

SAPTBG – Substance Abuse Prevention and Treatment Block Grant

SCHIP – State Children’s Health Insurance Program

SOAR – SSI and SSDI Outreach, Access and Recovery

SSA – U.S. Social Security Administration

SSBG – Social Services Block Grant

SSDI – Social Security Disability Insurance

SSI – Supplemental Security Income

STD – Sexually Transmitted Diseases

TANF – Temporary Assistance for Needy Families

TB – Tuberculosis

TIP – Treatment Improvement Protocol

USICH – see ICH

VA – U.S. Department of Veterans Affairs

Appendix D: Membership of the Secretary’s Work Group

Work Group Chair

Jerry Regier

Principal Deputy/ Assistant Secretary for Planning and Evaluation, Office of the Secretary

Richard Campanelli, Counselor for Human Service Policy

Cynthia Kenny, Policy Coordinator, Office of the Executive Secretary

Josephine Robinson, Director, Office of Community Services

Marsha Werner, Social Services Program Specialist, Office of Community Services

Edwin Walker, Deputy Assistant Secretary for Policy & Programs

Harry Posman, Executive Secretary, Office of the Assistant Secretary for Aging

Greg Morris, Director

Maria Cora Chua Tracy, Disabled and Elderly Health Programs Group, Center for Medicaid and State Operations

Lyman Van Nostrand, Director, Office of Planning and Evaluation

Lynnette Araki, Program Analyst, Office of Planning and Evaluation

Denise Juliano-Bult, Chief, Systems Research Program, Division of Services and Integration Research, National Institute of Mental health

Dr. Margaret Giannini, Director

Eileen Elias, Deputy Director

Substance Abuse and Mental Health Services Administration

Elaine Parry, Director of Special Initiatives, Immediate Office of the Administrator

Charlene Le Fauve, Chief, Co-Occurring and Homeless Activities Branch; Acting Chief, Data Infrastructure Branch, Center for Substance Abuse Treatment

Larry Rickards,Chief, Homeless Programs Branch, Center for Mental Health Services

Kathleen Heuer, Deputy Assistant Secretary for Performance and Planning and Acting Chief Information Officer

Richard Thurman, Deputy Assistant Secretary for Budget

Barbara Pisaro Clark, Deputy Director, Office of Human Services Legislation

Barbara Broman, Deputy to the Deputy Assistant Secretary, Human Services Policy

Robert Keith, Office of General Counsel

Diana Merelman, Office of General Counsel

James Mason, Senior Advisor to the Director, Intergovernmental Affairs

Heather Ransom, Director, Division of Property Management

Work Group Staff

Peggy Halpern, Policy Analyst, Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation

Anne Fletcher, Social Science Analyst, Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation

Flavio Menascé, Presidential Management Fellow, Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation

Members of the Strategic Action Plan Subcommittee

Anne Fletcher , Social Science Analyst, Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation

Peggy Halpern , Policy Analyst, Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation

Flavio Menascé , Presidential Management Fellow, Office of Human Services Policy, Office of the Assistant Secretary for Planning and Evaluation

Lynnette Araki , Program Analyst, Office of Planning and Evaluation, Health Resources and Services Administration

Capt. Rebecca S. Ashery , Public Health Analyst, Office of Minority and Special Populations, Health Resources and Services Administration

Benita Baker ,Public Health Analyst, Division of Healthy Start and Perinatal Services, Maternal and Child Health Bureau, Health Resources and Services Administration

Joanne Gampel, Social Science Analyst, Division of State and Community Assistance, Co-Occurring and Homeless Activities Branch, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration

Denise Juliano-Bult , Chief, Systems Research Program, Division of Services and Intervention Research, National Institute of Mental Health, National Institutes of Health

Charlene LeFauve , Chief, Co-Occurring and Homeless Activities Branch, Acting Chief, Data Infrastructure Branch, Center for Substance Abuse Treatment, Division of State and Community Assistance, Substance Abuse and Mental Health Services Administration

James Mason , Senior Advisor to the Director, Intergovernmental Affairs

Valerie Mills, Senior Public Health Advisor, Office of Policy, Planning and Budget, Substance Abuse and Mental Health Services Administration

Elaine Parry , Director of Special Initiatives, Immediate Office of the Administrator, Substance Abuse and Mental Health Services Administration

Harry Posman ,Executive Secretary, Office of the Assistant Secretary for Aging, Administration on Aging

Kathy Rama , Technical Director, Division of Advocacy and Special Issues, Disabled and Elderly Health Programs Group, Center for Medicaid and State Operations, Centers for Medicare and Medicaid Services

Larry Rickards , Chief, Homeless Programs Branch, Center for Mental Health Services, Substance Abuse and Mental Health Services Administration

Idalia Sanchez, Associate Director for Policy, Chief, Office of Policy Development, Division of Science and Policy, HIV/AIDS Bureau, Health Resources and Services Administration

Marsha Werner , Social Services Program Specialist, Office of Community Services, Administration for Children and Families

Appendix E: Comparison of Goals and Strategies:

2003 Strategic Action Plan and 2007 Strategic Action Plan

The purpose of this appendix is to demonstrate how the goals and strategies from the original strategic action plan evolved into the new, revised framework.  The table below shows how each original goal and strategy was either reordered, reframed, renumbered, deleted, and/or unchanged, and which goals and strategies are entirely new to the plan (these actions can be found in the ‘Action’ column).  In the ‘Goal/Strategy’ column each crossed-off section indicates language from the original plan that was either reframed or deleted altogether.

Poverty Solutions at the University of Michigan

Explore Poverty Solutions’ research on homelessness in the journal articles, working papers, policy briefs, news releases, and ongoing research projects listed below.

Homelessness Research Scholars

Barbara L. Brush

Carol J. and F. Edward Lake Professor of Population Health, School of Nursing

Jennifer Erb-Downward

Director of Housing Stability Programs and Policy Initiatives

In the Media

The Alpena News | Apr. 11, 2024

Column: Kids should not be left behind

EdSource | Apr. 3, 2024

Only 1 in 6 homeless infants and toddlers enrolled in early childhood programs in California, study finds

New York Times / The Upshot | Oct. 2, 2023

The Americans Most Threatened by Eviction: Young Children

Publications.

By Jennifer Erb-Downward and Amanda Nothaft

By Kasia Klasa, Naquia Unwala, Scott L. Greer, Julia A. Wolfson, and Charley E. Willison

By Jennifer Erb-Downward and Michael Blakeslee

By SchoolHouse Connection and Poverty Solutions at the University of Michigan

By Jennifer Erb-Downward and Safiya Merchant

By Michael Evangelist and H. Luke Shaefer

By Jennifer Erb-Downward and Payton Watt

By Jennifer Erb-Downward

By Jennifer Erb-Downward and Michael Evangelist

News Releases

Developing youth leadership to end youth homelessness

Chronic housing instability poses educational risk for Detroit students

New policy brief from Wayne State University, Poverty Solutions reveals Detroit schools under-identify homeless students

Research projects.

Poverty Solutions supports several projects that aim to promote a better understanding of the causes and consequences of homelessness and identify potential points of intervention.

Work Related Transdiagnostic Cognitive Behavioral Therapy for Unemployed Homeless Persons with Anxiety and Depression

Improving Coordination to Reduce Service Gaps and Increase Efficacy in Child and Family Homelessness Policy and Programming The project: The national system for preventing and addressing homelessness, known as the Continuum of Care (CoC), is not well understood, and the capacity of these systems to successfully address homelessness has never been evaluated. The Continuums of Care are most often locally-organized groups of actors that receive funding from the federal government to create and…

Breaking the Cycle: Refining the Trauma-Informed Clinical Ethnographic Narrative Interview (CENI) The project: In 2016, over 9,700 family households across Michigan, accounting for 24,766 people, entered an emergency shelter due to homelessness. The majority of these households were headed by a single female with one or two children under 11 years of age. Prior research has demonstrated that more than 90% of mothers who become homeless…

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• Housing Insight

A New Conversation About Homelessness

Americans are ready for a national conversation about why housing remains out of reach for so many. The Housing Narrative Lab is a national communications and narrative research hub that lifts up the stories of people facing homelessness and housing insecurity and the systems that keep them from finding and keeping a home.

The Latest from Housing Narrative Lab

Housing Narrative Awards

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Narrative tip: show root causes.

The stories we tell matter. And who shapes and tells the stories has power. At the Housing Narrative Lab, we work to build narrative power with those most impacted by homelessness. By fostering greater public understanding of the root causes that force our neighbors into homelessness – lack of affordable housing, low-paying jobs, racist and exclusionary housing practices – we lay the groundwork for local and national solutions.

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New Partnership with Community Solutions to Research Homelessness Policy

Community solutions — a leading nonprofit committed to creating a lasting end to homelessness — and researchers from boston university and cornell university will study the landscape of homelessness public policy and its consequences.

Numerous government agencies at all levels make public policies that are influential to the well-being of people experiencing homelessness in the U.S. But, the way these decisions get made and how they’re implemented aren’t visible to the public or even other policy makers. In many cases, they are not considered part of homelessness policy at all. Think: land use policy. Or policing.

Very little is known about the types of policies that are targeted toward homelessness at the local level, how these policies are organized around different goals that may or may not work to effectively reduce homelessness, and whether these goals are carried out in implementation.

Two prominent homelessness researchers are embarking on a three-year research project, “Invisible Policymaking: The Hidden Actors Shaping Homelessness,” in conjunction with Community Solutions in order to explore these issues more fully. This project emerged from an initial partnership between Community Solutions and the Boston University Initiative on Cities on the 2021 Menino Survey of Mayors report, “Mayors and America’s Homelessness Crisis. ”

The research aims to answer:

• What is the full landscape of homelessness policy?
• How does homelessness policy get made?
• What are the consequences of these policy decisions for unhoused people?

“A large body of research shows that high housing costs lead to homelessness. The solution to this problem is political. Policymakers must recognize inadequate affordable housing and homelessness as serious and intertwined problems,” said Katherine Levine Einstein , Associate Professor of Political Science at Boston University. “Our research partnership with Community Solutions explores different policy approaches to ending homelessness — and the extent to which policymakers centralize or fragment their housing and homelessness policies.”

In partnership with Community Solutions, Dr. Katherine Levine Einstein of Boston University and Dr. Charley E. Willison of Cornell University will be studying how the structure of public policy making in both decision-making and policy implementation contributes to homelessness.

“This research will strengthen our knowledge about how policy making and policy implementation across different levels of government will inform our strategy to drive reductions, and eventually end, homelessness in communities,” said Adam Ruege , the Learning System & Evaluation Portfolio Lead for Community Solutions . “We are so very excited for this new partnership and the new insights we will gain from their work.”

Invisible Policy: The Hidden Actors Shaping Homelessness

Throughout all levels of government, decisions are being made that directly impact people experiencing homelessness — but these decisions aren’t typically considered to be part of homelessness policy.

For example, local planning and zoning boards make decisions that impact what housing gets built and where and in turn, impacts housing costs and displacement. Yet land use policy and the dynamics of public planning and zoning board meetings are not typically considered to be homelessness policy.

Policy could also be a tool to effectively reduce homelessness. Einstein and Willison will study this too.

“Most homelessness research is on best practice solutions. We know affordable housing, and permanent supportive housing, are the best ways to end homelessness. Yet little research to date has examined policy uptake, or political factors shaping policy choices,” said Charley E. Willison , Assistant Professor of Public Health at Cornell University. “Cities face political pressure to enlist punitive, criminalization responses, over evidence-based housing solutions, which actually facilitates cycles of homelessness. Our research explores political determinants influencing different local-policy approaches.”

Who influences homelessness in your community? Mayors. City councils. County execs. Police. Planning and zoning boards. Public Health Departments. Public Works. Public Housing Authorities. Even parks departments.

The decisions of all these players can have an impact on homelessness. Einstein and Willison will study how these players across levels of government make decisions that affect homelessness. In particular, they’re interested in how decisions by these actors can lead to policy change targeting population-level reductions in homelessness.

They plan to use a variety of different methodologies to unpack these questions at both the national and local scale. At the national scale, they will explore:

• National administrative data from cities and Continuums of Care (CoCs)
• Menino Survey of Mayors
• Survey of CoCs

In close consultation with Community Solutions, they will also select four cases for in-depth investigation. These case studies will feature detailed interviews with key stakeholders — including bureaucrats across levels of government and individuals with lived experience of homelessness — alongside the analysis of large databases, including police reports and land use/zoning decisions.

In order to further understand the challenges local actors face in designing and delivering solutions to homelessness, Einstein and Willison plan to examine policies as part of their case analysis. This will allow them to investigate the complex relationships between state level decision-making, counties, and local government actors (cities and CoCs), including funding arrangements and funding decisions in practice.

The Research Team

Katherine Levine Einstein (PhD, Harvard University) is an associate professor of political science at Boston University (BU) and a faculty fellow at the BU Initiative on Cities . Her research asks whether local policies represent community preferences and what factors hamper politicians from addressing critical challenges in their communities — with a substantive focus on housing policy. Her 2019 book with BU colleagues David Glick and Maxwell Palmer, Neighborhood Defenders: Participatory Politics and America’s Housing Crisis (Cambridge University Press) shows how neighborhood participation in the housing permitting process exacerbates existing political inequalities, limits the housing supply, and contributes to the current affordable housing crisis. She has also published multiple peer-reviewed journal articles and policy reports on racial discrimination and inequality, housing policy, urban politics and policy, and the policy process. She currently serves as one of the principal investigators of the Menino Survey of Mayors , a multi-year data set of survey-interviews of U.S. mayors exploring a wide variety of political and policy issues.

Charley E. Willison (PhD, University of Michigan) is an assistant professor of public health at Cornell University. She is a political scientist studying the relationships between local politics, intergovernmental relations, and public health political decision-making, with a primary focus on homelessness. Dr. Willison’s 2021 book, Ungoverned and Out of Sight: Public Health and the Political Crisis of Homelessness in the United States (Oxford University Press) examines why municipalities may use evidence-based approaches to address chronic homelessness in their jurisdictions or not. Her book won the 2022 Dennis Judd Best Book Award , which recognizes the best book on urban politics (domestic or international) published in the previous year. She is currently the co-principal investigator of the Continuums of Care Survey, a national survey of the governance structures responsible for designing and delivering solutions to homelessness in jurisdictions across the U.S., and how these systems respond to ongoing political and policy challenges. She has published multiple peer-reviewed articles and policy briefs on homelessness policy and politics in the U.S. and is actively engaged in research dissemination to policy makers, communities and the public.

Community Solutions is a nonprofit committed to creating a lasting end to homelessness that leaves no one behind. It leads Built for Zero, a movement of more than 100 communities in the United States working to measurably and equitably end homelessness. Using a data-driven methodology, these communities have changed how local systems work and the impact they can achieve. To date, 14 communities have reached a milestone known as functional zero, a milestone for ending homelessness for a population. Learn more at www.community.solutions or follow @CmtySolutions .

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• v.103(Suppl 2); Dec 2013

Homelessness Research: Shaping Policy and Practice, Now and Into the Future

All authors contributed equally to this editorial.

As this special issue of the journal well reflects, much progress has been made in homelessness research. That progress has been matched with advances in homelessness policy and programming, nearly all of it informed by the contributions of the research community. While the imperatives of policy-making have required decisions to be made with imperfect knowledge, a substantial enough convergence of theory and evidence has enabled policymakers to shift homelessness policy and practice in important ways. Those shifts have also prefigured some of policymakers’ needs from the research community in the future.

The US Interagency Council on Housing (USICH) has recently called for a “Housing First” approach across homeless programs, 1 meaning that they have urged federal agencies and their state and local partners to prioritize housing interventions to address homelessness, with the necessary services and supports to follow. While the “housing first” phrase is often associated with a specific model of permanent supported housing, such as the Pathways program in New York City, in this case the phrase is being applied more broadly to advocate for “housing led” policies across subpopulations, including youth, families and nonchronically homeless adults. Of course “housing first” doesn’t mean “housing only,” so there’s much room for further knowledge about how health and social services can support the permanent housing goal, especially for populations with special needs.

US Veteran Larry Mainor recently ended three decades of homelessness through the efforts of "Unsheltered No More" in Atlanta, GA. Photograph by Jaime Henry-White. Printed with permission of AP Images.

The evidence base for this Housing First strategy comes from both the fairly robust research literature on the effectiveness of permanent supported housing, such as from the Collaborative Initiative to End Chronic Homelessness 2 and the Housing and Urban Development Veterans Affairs Supportive Housing (HUD-VASH) program, 3 but also from an emerging evidence base on the effectiveness of homelessness prevention and rapid rehousing (HPRP) programs. 4 The federal HUD HPRP program, funded with $1.5 billion through the American Recovery and Reinvestment Act, provided for a national demonstration of a program model that had strong theoretical support, but limited empirical evidence. Because of that program, and other initiatives like it, including the VA’s new Supportive Services to Veterans and Their Families, the evidence base is growing and indicates that the vast majority of families and nonchronically homeless single adult households can resolve their homelessness with timely, intensive, but also relatively brief financial and social assistance.

But none of these programs is perfect, and no program model seems to work for everyone. Returns to homelessness, although relatively infrequent, occur in the fully rent-subsidized and case-managed permanent supported housing programs, as well as in the HPRPs. At least one major thrust of the future research agenda will need to focus on why these interventions don’t always work for everyone, and what more needs to be done to make housing attainable (and sustainable) for all. And while conventional rental housing has been the primary approach to ending homelessness, it may well be that some housing models will need to look different, such as assisted living for aging populations, some group living for youth recently exiting foster care and juvenile justice, or safe havens for people unable to comply with conventional housing rules. What is clear, however, is that federal homelessness policy, most notably through the Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009 and the VA’s new initiatives to end veteran homelessness in 2015, has sharpened the focus onto the housing endgame, and a clear need is evident for research in support of that goal.

From a public health perspective, the emerging evidence also shows how housing serves as a powerful public health intervention. Especially in the realm of HIV prevention and treatment, the evidence base is convincing that stabilizing housing for people who are homeless is associated with improved treatment adherence, and reduced risk behavior, thus an important tool both for increasing survival and reducing infections. 6 Other populations with special needs, such as people with severe mental illness and people with addictions, also reduce their use of hospitals, shelters and jails, as housing functions to improve not only housing stability, but health behaviors and access to more regular forms of care. 6 Yet even considering significant changes in health services use and outcomes, such housing interventions cannot be cost effective for every subpopulation. Nevertheless, the public health and societal benefits of housing for people who were once homeless need to be better documented and understood to continue to inform policymakers and program design. Such evidence has proven to be key to mobilizing political support for expanded housing resources for these populations, and will continue to be important for making the case in the future.

The evidence is now clear that the single adult homeless population is aging. 7 Based on 3 decennial censuses (1990, 2000, 2010), single adult homelessness has been revealed to be part of an “Easterlin (cohort) effect,” 8 disproportionately impacting babyboomers, but especially the latter half of the cohort born between 1955 and 1965. By 1990, the latter half of the babyboom cohort would have averaged 30 years in age, and Census data reveals that they were already the predominant subpopulation among the adult homeless population; they have since remained so. The immediate, and perhaps urgent, implication is that with a substantially lower life expectancy than the general population, most of the adult homeless are facing premature aging-related morbidity, disability, and death, in the next fifteen years. This will have significant repercussions for health care delivery and costs, for housing and long-term care demand, and for the capacity of current supported housing programs to serve an aging and frailer population.

Of a longer-term concern is the etiology of this cohort effect. Easterlin’s hypothesis is that such cohort effects result from population surges that produce excess labor supply, which in turn thwarts labor force attachment among young adults in the cohort at disproportionately high rates. The effect could be amplified if combined with an economic crisis (a period effect) that produces even greater rates of unemployment and labor force nonparticipation among young adults in the cohort. Indeed, such would have been the case when the latter half of the babyboom cohort came into young adulthood during the back-to-back and comparatively deep recessions of the late 1970s and early 1980s. Many who failed to make connections to the labor market during those periods may have been permanently dislocated economically and socially; some turned to illegal activities including drug sales to survive, along with the attendant risks for violence, addiction, incarceration and family and community disruption. Thus, one critical concern now is whether the most recent recession and its aftermath, combined with the coming of age of the so-called millennial generation, will produce its own permanent dislocations among yet another cohort of vulnerable young adults, including returning soldiers from Iraq and Afghanistan. And if it does, what will we do differently than we did in the 1980s, to better improve and sustain the connections of young people to work, family, community, and housing? This is a pressing research and intervention agenda that calls for a reexamination of our emergency services approach that proved so limited in the face of the problem in the past. Will the new “housing first” approaches prove adequate to the task? Will they need to be supplemented with labor market-based strategies? How important could employment programs be to averting premature disability, social marginalization, substance dependence, and the related health problems that could otherwise result from another possible Easterlin effect in homelessness?

A final set of research concerns relates to the Affordable Care Act (ACA). Most people who experience homelessness, especially as adults unaccompanied by children, are uninsured (and male). 9 Without a Supplemental Security Income (SSI)–determined disability, and with many being relatively able-bodied, these adults have spent much of their lives without access to regular health care. Along with their often marginally housed contemporaries, they are going to be among the chief beneficiaries of the Medicaid expansion of the ACA. Yet this expansion will also raise many questions, including those about the adequacy of the health care delivery system to provide access to this population; those about how to integrate primary care and substance abuse treatment, given both the need for such treatment and the barriers to primary care for this group; and those about how improved access to health care can be used to identify housing needs and barriers—and interventions—that would mitigate homelessness. Given its experience in integrating behavioral health and primary care for indigent adults, the US Department of Veterans Affairs could be an important source of experience for the nonveteran health delivery system. The Home and Community-Based Services waiver option under the ACA raises the possibility that Medicaid could be used to fund the transition from homelessness to housing, such as through evidence-based practices like Critical Time Intervention. Defined benefits for particular subpopulations, like adults who are homeless or exiting homelessness, could likewise create eligibility for special housing support-related benefits and coordinated care models that could fund the supported services of supported housing—an otherwise difficult resource to obtain. The variability in states’ adoption of Medicaid expansion will also create natural experiments of whether and how Medicaid can and is being used to reduce homelessness. The ACA promises to provide tremendous opportunities for research on services that can enhance and support the federal goal of ending homelessness for everyone.

Acknowledgments

The authors gratefully acknowledge the editorial assistance of Thomas Byrne.

Homelessness and Housing

The Urban@UW’s Homelessness Research Initiative aims to be a nexus for researchers and practitioners to exchange discoveries, experiences, and ideas on the topics of homelessness, housing access, and their drivers and consequences. By connecting the efforts of faculty from across disciplines and campuses, the HRI serves to amplify research findings and translate them to a broader community of state and local governments, nonprofit providers, philanthropies, and others dedicated to improving the lives of those experiencing homelessness. The Homelessness Research Initiative unites faculty efforts from across the University of Washington to address homelessness through a research lens.

A study of the recent King County initiative moving people from homeless shelters to hotel rooms to help slow the spread of COVID-19, part of the Homelessness Research Initiative, is co-authored by  Rachel Fyall  and  Gregg Colburn , HRI faculty co-leads. Read the final report here.

Homelessness on UW’s Campuses

Interested in staying in the loop? We have two listservs:

Homelessness Research:  Click Here to Join Our Listserv for Homelessness Research

Housing Research: Click Here to Join Our Listserv for Housing Research

Homelessness and housing: initiative leadership.

Faculty Co-Chairs: Gregg Colburn , Assistant Professor, Runstad Department of Real Estate; and  Rachel Fyall , Associate Professor, Evans School of Public Policy and Governance

Current Projects

Doorway project.

Lead: Seema Clifasefi

The  Doorway Project  aims to create a pilot café/navigational model that will engage the University District’s homeless, street-involved or marginalized youth; UW students and faculty; and University District service providers in innovative and impactful ways.

The place-based studio/community café will catalyze social innovation through deep participation and mutual learning where interdisciplinary community-campus partnership projects can occur on an ongoing basis. Through participatory research methodologies utilized alongside empathy-centered visual reporting and intervention design, the faculty leads plan to strengthen community resilience and capacity while increasing empathy and understanding of the homeless youth population.

The project is part of a broader initiative which will work to address youth homelessness in the University district, and includes collaboration with the Carlson Leadership and Public Service Center to build upon the services of current local providers in an iterative and community-engaged manner. Learn more about the  Doorway Project .

Sound Communities

Co-leads: Gregg Colburn , Al Levine , Rick Mohler

Sound Communities envisions a Puget Sound region where all of us live in vibrant, thriving communities with access to public transit and amenities, giving us the freedom to make our best lives for ourselves and our families. Our mission is to promote the development of complete, walkable, equitable and inclusive neighborhoods at scale across the Puget Sound region in concert with the region’s historic investment in transit.

Primary goals:

• Encourage, support, and enable cities and counties to create and update station area plans based on community vision to achieve complete communities based on equitable transit-oriented development
• Provide cities and counties with the capability to acquire, assemble, lease, or landbank land within and adjacent to station areas to be developed into affordable and mixed-income housing
• Provide cities and counties with the means to partner with the development community to produce affordable and mixed-income housing and related infrastructure

Click here to explore the recently launched website

Past Projects

An analysis of investments in non-congregate emergency shelter in king county during the covid-19 pandemic.

Co-leads: Gregg Colburn , Rachel Fyall

King County recently began an initiative to move people experiencing homelessness out of emergency shelters into hotels and motels. In partnership with the County and with funding support from the Gates Foundation and Urban@UW, the aim of this project is to understand the impact of living in a non-congregate environment on shelter-stayers’ physical and mental well-being, ability to participate in the workforce, and outlook on the future. Results will establish an evidence base for key decisions that the County faces as it emerges from the COVID-19 crisis. Because a return to normal (highly crowded homeless shelters) may not be an option in the near-to-medium term due to public health concerns, the County must formulate new ideas to house and support people experiencing homelessness.

Click here to read the October 7 press release

Click here to read the final report, published December 2

• Understanding Housing and Food Insecurity among University of Washington Students

Co-leads:  Rachel Fyall ,  Lynne Manzo ,  Christine Stevens

This survey project investigates the prevalence and characteristics of University of Washington-Seattle, Tacoma and Bothell students experiencing housing and food insecurity. Preliminary findings about students’ experiences of homelessness on all three University of Washington campuses have been released. With a 20% response rate, it examines the diverse population that may bear the burden of inequities, and has paved the way for subsequent qualitative analysis of students’ lived experiences.

Click here to read about student food and housing insecurity on UW’s campuses

This research project was spurred by an Urban@UW meeting in 2016, which led to the formation of the Homelessness Research Initiative. This project is thus an example of how the Homelessness Research Initiative aims to bring faculty together across disciplines to contribute to efforts to understand and address homelessness in our area.

Critical Narratives of Homelessness

Team: Charlie Collins , Sarah  Elwood ,  Amy Hagopian ,  Victoria Lawson ,  Lynne Manzo, Graham Pruss , Kathryn Pursch-Cornforth ,  Amoshaun Toft

The faculty and staff team is currently developing curriculum elements that will challenge dominant negative cultural narratives through education, engagement with local organizations, and advancement of student capacities for social change. Through this curriculum, faculty members aim to structure a place-based and community engaged process that could result in a public deliverable created by the students and their collaborators. In changing individual perception of narratives of homelessness, the coursework can provide an opportunity for students to become catalysts of thinking for a broader audience.

Primary learning goals for curriculum:

• Understand cultural stereotypes and political discourses around class and homelessness
• Identify avenues for making greater narrative change or organizational resistance
• Challenge dominant narrative (intervene, generate interrupters)
• Develop/deepen student competency around cross-boundary/interdisciplinary collaboration
• Work with diverse communities towards a common goal

Check out the Critical Narratives of Homelessness: 2017-8 Report

Publications

• Impact of Hotels as Non-Congregate Emergency Shelters
• Critical Narratives of Homelessness: 2017-8 Report
• Homelessness Research Initiative: Faculty Highlights Report
• Any Hungry Husky
• UW Food Pantry
• Emergency Aid
• University District Food Bank
• ROOTS Young Adult Shelter  provides safe emergency overnight shelter for young adults ages 18-25
• UW Seattle Student Life Resources
• Adjustments to UW Financial Aid
• University District Resources
• The YMCA Accelerator can help link those aged 18-24 with housing, case management, and employment
• To access campus resources for students who have experienced foster care, please connect with the UW Champions Program at [email protected]
• Food Pantry on campus
• The Office of Student Advocacy and Support provides referral and support services for emergency housing, food and support. Email: [email protected]
• FREE Student Counseling
• Shelter for young adults aged 18-24
• St. Leo Food Connection
• The Rainbow Center  expands resources and safe space for the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community
• The Oasis Youth Center  transforms the lives of queer youth by creating a safe place to learn, connect, and thrive
• Center for Equity and Inclusion
• Associated Ministries
• Cedar Park Northshore Food Bank
• Maltby Food Bank
• UW Bothell CARE Team
• The YWCA Pathways for Women emergency shelter provides safe housing and resources for single women and mothers with children experiencing homelessness in Snohomish County

Statewide and beyond

• For statewide referrals to food, housing, and many other resources, call 211 on your phone or visit Washington 2-1-1 at https://win211.org/

Partners and Collaborators

• Center for Studies in Demography and Ecology
• Community Engagement and Leadership Education (CELE) Center
• College of Arts & Sciences
• College of Built Environments
• College of Engineering
• eScience Institute
• Evans School of Public Policy & Governance
• Office of Regional & Community Relations
• Office of the Provost
• School of Dentistry
• School of Law
• School of Nursing
• School of Public Health
• School of Social Work
• The Information School
• West Coast Poverty Center
• UW Addressing Homelessness

Related Coursework

ENV H 443: Housing and Health

HSERV 490/590: Homeless in Seattle: Destitute Poverty in the Emerald City

GEOG 271: Geography of Food and Eating

GEOG 277: Geography of Cities

GEOG 342: Geography of Inequality

GEOG 377: Urban Political Geography

GEOG 445: Geography of Housing

GEOG 470: The Cultural Politics of Food

GEOG 490: Field Research: The Seattle Region

LAW E 525: Poverty Law

MEDEX 580: Homelessness in Seattle

NUTR 303: Food Systems: Individual to Population Health

NUTR 412/512: United States Food Systems Policy

NUTR 513: Food and Society: Exploring Eating Behaviors in a Social, Environmental, and Policy Context

NUTR 514: Sustainable Food Systems for Population Health

ORALM 651: Health and Homelessness

ORALM 652: Health Issues in the Homeless and Underserved

PEDS 530: Homeless Youth and their Medical Care

PUBPOL 561/URBDP 561: Urban Economics and Public Policy

PUBPOL 564: Housing and Social Policy

R E 401/563: Housing Markets and Policy

R E 464/564: Affordable Housing

R E 466/565: Advanced Housing Studies

SOC 420: Sociology of Food

SOC 459: The New Inequality

SOC W 554: People, Place, Equity

URBDP 451: Housing

URBDP 457: Housing in Developing Countries

URBDP 562: Introduction to Neighborhood Planning and Community Development

T GEOG 321: Urban Geography

T URB 220: Introduction to Urban Planning

T URB 480: Housing in the United States

B HLTH 220: Community Nutrition

B HLTH 405: Race, Power, and Food

BIS 448: Social Policy

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© 2024 University of Washington | Seattle, WA

• Open access
• Published: 22 August 2017

Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples

• Mzwandile A. Mabhala   ORCID: orcid.org/0000-0003-1350-7065 1 , 3 ,
• Asmait Yohannes 2 &
• Mariska Griffith 1  

International Journal for Equity in Health volume  16 , Article number:  150 ( 2017 ) Cite this article

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It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation, with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing, to understanding the social context of homelessness and social interventions to prevent it.

However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves. This study aims to examine the stories of homeless people to gain understanding of the social conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

Twenty-six semi-structured interviews were conducted with homeless people in three centres for homeless people in Cheshire North West of England.

The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience capacity to cope with life challenges created by series of adverse incidents in one’s life. The data show that final stage in the process of becoming homeless is complete collapse of relationships with those close to them. Most prominent pattern of behaviours participants often describe as main causes of breakdown of their relationships are:

engaging in maladaptive behavioural lifestyle including taking drugs and/or excessive alcohol drinking

Being in trouble with people in authorities.

Homeless people describe the immediate behavioural causes of homelessness, however, the analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

It is increasingly acknowledged that homelessness is a more complex social and public health phenomenon than the absence of a place to live. This view signifies a paradigm shift, from the definition of homelessness in terms of the absence of permanent accommodation [ 1 , 2 , 3 , 4 , 5 ], with its focus on pathways out of homelessness through the acquisition and maintenance of permanent housing [ 6 ], to understanding the social context of homelessness and social interventions to prevent it [ 6 ].

Several studies explain the link between social factors and homelessness [ 6 , 7 , 8 , 9 , 10 ]. The most common social explanations centre on seven distinct domains of deprivation: income; employment; health and disability; education, skills and training; crime; barriers to housing and social support services; and living environment [ 11 ]. Of all forms, income deprivation has been reported as having the highest risk factors associated with homelessness [ 7 , 12 , 13 , 14 ]: studies indicate that people from the most deprived backgrounds are disproportionately represented amongst the homeless [ 7 , 13 ]. This population group experiences clusters of multiple adverse health, economic and social conditions such as alcohol and drug misuse, lack of affordable housing and crime [ 10 , 12 , 15 ]. Studies consistently show an association between risk of homelessness and clusters of poverty, low levels of education, unemployment or poor employment, and lack of social and community support [ 7 , 10 , 13 , 16 ].

Studies in different countries throughout the world have found that while the visible form of homelessness becomes evident when people reach adulthood, a large proportion of homeless people have had extreme social disadvantage and traumatic experiences in childhood including poverty, shortage of social housing stocks, disrupted schooling, lack of social and psychological support, physical, sexual, and emotional abuse, neglect, dysfunctional family environments, and unstable family structures, all of which increase the likelihood of homelessness [ 10 , 13 , 14 ].

Furthermore, a large body of evidence suggests that people exposed to diverse social disadvantages at an early age are less likely to adapt successfully compared to people without such exposure [ 9 , 10 , 13 , 17 ], being more susceptible to adopting maladaptive coping behaviours such as theft, trading sex for money, and selling or using drugs and alcohol [ 7 , 9 , 18 , 19 ]. Studies show that these adverse childhood experiences tend to cluster together, and that the number of adverse experiences may be more predictive of negative adult outcomes than particular categories of events [ 17 , 20 ]. The evidence suggests that some clusters are more predictive of homelessness than others [ 7 , 12 ]: a cluster of childhood problems including mental health and behavioural disorders, poor school performance, a history of foster care, and disrupted family structure was most associated with adult criminal activities, adult substance use, unemployment and subsequent homelessness [ 12 , 17 , 21 ]. However, despite evidence of the association between homelessness and social factors, there is very little research that examines the wider social context within which homelessness occurs from the perspective of homeless people themselves.

This paper adopted Anderson and Christian’s [ 18 ] definition, which sees homelessness as a ‘function of gaining access to adequate, affordable housing, and any necessary social support needed to ensure the success of the tenancy’. Based on our synthesis of the evidence, this paper proposes that homelessness is a progressive process that begins at childhood and manifests itself at adulthood, one characterised by loss of the personal resources essential for successful adaptation. We adopted the definition of personal resources used by DeForge et al. ([ 7 ], p. 223), which is ‘those entities that either are centrally valued in their own right (e.g. self-esteem, close attachment, health and inner peace) or act as a means to obtain centrally valued ends (e.g. money, social support and credit)’. We propose that the new paradigm focusing on social explanations of homelessness has the potential to inform social interventions to reduce it.

In this study, we examine the stories of homeless people to gain understanding of the conditions under which homelessness occurs, in order to propose a theoretical explanation for it.

The design of this study was philosophically influenced by constructivist grounded theory (CGT). The aspect of CGT that made it appropriate for this study is its fundamental ontological belief in multiple realities constructed through the experience and understanding of different participants’ perspectives, and generated from their different demographic, social, cultural and political backgrounds [ 22 ]. The researchers’ resulting theoretical explanation constitutes their interpretation of the meanings that participants ascribe to their own situations and actions in their contexts [ 22 ].

The stages of data collection and analysis drew heavily on other variants of grounded theory, including those of Glaser [ 23 ] and Corbin and Strauss [ 24 ].

Setting and sampling strategy

The settings for this study were three centres for homeless people in two cities (Chester and Crewe) in Cheshire, UK. Two sampling strategies were used in this study: purposive and theoretical. The study started with purposive sampling and in-depth one-to-one semi-structured interviews with eight homeless people to generate themes for further exploration.

One of the main considerations for the recruitment strategy was to ensure that the process complies with the ethical principles of voluntary participation and equal opportunity to participate. To achieve this, an email was sent to all the known homeless centres in the Cheshire and Merseyside region, inviting them to participate. Three centres agreed to participate, all of them in Cheshire – two in Chester and one in Crewe.

Chester is the most affluent city in Cheshire and Merseyside, and therefore might not be expected to be considered for a homelessness project. The reasons for including it were: first, it was a natural choice, since the organisations that funded the project and the one that led the research project were based in Chester; second, despite its affluence, there is visible evidence of homelessness in the streets of Chester; and third, it has several local authority and charity-funded facilities for homeless people.

The principal investigator spent 1 day a week for 2 months in three participating centres, during that time oral presentation of study was given to all users of the centre and invited all the participants to participate and written participants information sheet was provided to those who wished to participate. During that time the principal investigator learned that the majority of homeless people that we were working with in Chester were not local. They told us that they came to Chester because there was no provision for homeless people in their former towns.

To help potential participants make a self-assessment of their suitability to participate without unfairly depriving others of the opportunity, participants information sheet outline criteria that potential participants had to meet: consistent with Economic and Social Research Council’s Research Ethics Guidebook [ 25 ], at the time of consenting to and commencing the interview, the participant must appear to be under no influence of alcohol or drugs, have a capacity to consent as stipulated in England and Wales Mental Capacity Act 2005 [ 26 ], be able to speak English, and be free from physical pain or discomfort.

As categories emerged from the data analysis, theoretical sampling was used to refine undeveloped categories in accordance with Strauss and Corbin’s [ 27 ] recommendations. In total 26 semi-structured interviews were carried out. Theoretical sampling involved review of memos or raw data, looking for data that might have been overlooked [ 27 , 28 ], and returning to key participants asking them to give more information on categories that seemed central to the emerging theory [ 27 , 28 ].

The sample comprised of 22 male and 4 female, the youndgest participant was 18 the eldest was 74 years, the mean age was 38.6 years. Table 1 illustrates participant’s education history, childhood living arrangements, brief participants family and social history, emotional and physical health, the onset of and trigger for homelessness.

Ethical approval

Ethical approval was obtained from the Research Ethics Committee of the University of Chester. The centre managers granted access once ethical approval had been obtained, and after their review of the study design and other research material, and of the participant information sheet which included a letter of invitation highlighting that participation was voluntary.

Data analysis

In this study data collection and analysis occurred simultaneously. Analysis drew on Glaser’s [ 23 ] grounded theory processes of open coding, use of the constant comparative method, and the iterative process of data collection and data analysis to develop theoretical explanation of homelessness.

The process began by reading the text line-by-line identifying and open coding the significant incidents in the data that required further investigation. The findings from the initial stage of analysis are published in Mabhala [ 29 ]. The the second stage the data were organised into three themes that were considered significant in becoming homeless (see Fig. 1 ):

Engaging in maladaptive behaviour

Being in trouble with the authorities.

Being in abusive environments.

Social explanation of becoming homeless. Legend: Fig. 1 illustrates the process of becoming homeless

The key questions that we asked as we continued to interrogate the data were: What category does this incident indicate? What is actually happening in the data? What is the main concern being faced by the participants? Interrogation of the data revealed that participants were describing the process of becoming homeless.

The comparative analysis involved three processes described by Glaser ([ 23 ], p. 58–60): each incident in the data was compared with incidents from both the same participant and other participants, looking for similarities and differences. Significant incidents were coded or given labels that represented what they stood for, and similarly coded or labeled when they were judged to be about the same topic, theme or concept.

After a period of interrogation of the data, it was decided that the two categories - destabilising behaviour, and waning ofcapacity for resilience were sufficiently conceptual to be used as theoretical categories around which subcategories could be grouped (Fig. 1 ).

Once the major categories had been developed, the next step consisted of a combination of theoretical comparison and theoretical sampling. The emerging categories were theoretically compared with the existing literature. Once this was achieved, the next step was filling in and refining the poorly defined categories. The process continued until theoretical sufficiency was achieved.

Figure 1 illustrates the process of becoming homeless. The analysis revealed that becoming homeless is a process characterised by a progressive waning of resilience created by a series of adverse incidents in one’s life. Amongst the frequently cited incidents were being in an abusive environment and losing a significant person in one’s life. However, being in an abusive environment emerged from this and previously published studies as a major theme; therefore, we decided to analyse it in more detail.

The data further show that the final stage in the process of becoming homeless is a complete collapse of relationships with those with whom they live. The most prominent behaviours described by the participants as being a main cause of breakdown are:

Engaging in maladaptive behaviour: substance misuse, alcoholism, self-harm and disruptive behaviours

Being in trouble with the authorities: theft, burglary, arson, criminal offenses and convictions

The interrogation of data in relation to the conditions within which these behaviours occurred revealed that participants believed that their social contexts influenced their life chance, their engagement with social institution such as education and social services and in turn their ability to acquire and maintain home. Our experiences have also shown that homeless people readily express the view that behavioural lifestyle factors such as substance misuse and engaging in criminal activities are the causes of becoming homeless. However, when we spent time talking about their lives within the context of their status as homeless people, we began to uncover incidents in their lives that appeared to have weakened their capacity to constructively engage in relationships, engage with social institutions to make use of social goods [ 29 , 30 , 31 ] and maturely deal with societal demands.

Being in abusive environments

Several participants explicitly stated that their childhood experiences and damage that occurred to them as children had major influences on their ability to negotiate their way through the education system, gain and sustain employment, make appropriate choices of social networks, and form and maintain healthy relationships as adults.

It appears that childhood experiences remain resonant in the minds of homeless participants, who perceive that these have had bearing on their homelessness. Their influence is best articulated in the extracts below. When participants were asked to tell their stories of what led to them becoming homeless, some of their opening lines were:

What basically happened, is that I had a childhood of so much persistent, consistent abuse from my mother and what was my stepfather. Literally consistent, we went around with my mother one Sunday where a friend had asked us to stay for dinner and mother took the invitation up because it saved her from getting off her ass basically and do anything. I came away from that dinner genuinely believing that the children in that house weren’t loved and cared for, because they were not being hit, there was no shouting, no door slamming. [Marco]

It appears that Marco internalised the incidents of abuse, characterised by shouting, door slamming and beating as normal behaviour. He goes on to intimate how the internalised abusive behaviour affected his interaction with his employers.

‘…but consistently being put down, consistently being told I was thick, I started taking jobs and having employers effing and blinding at me. One employer actually used a “c” word ending in “t” at me quite frequently and I thought it was acceptable, which obviously now I know it’s not. So I am taking on one job after another that, how can I put it? That no one else would do basically. I was so desperate to work and earn my own money. [Marco]

Similarly, David makes a connection between his childhood experience and his homelessness. When he was asked to tell his life story leading to becoming homeless, his opening line was:

I think it [homelessness] started off when I was a child. I was neglected by my mum. I was physically and mentally abused by my mum. I got put into foster care, when I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. [David]

David and Marco’s experiences are similar to those of many participants. The youngest participant in this study, Clarke, had fresh memories of his abusive environment under his stepdad:

I wouldn't want to go back home if I had a choice to, because before I got kicked out me stepdad was like hitting me. I wouldn't want to go back to put up with that again. [I didn't tell anyone] because I was scared of telling someone and that someone telling me stepdad that I've told other people. ‘[Be] cause he might have just started doing again because I told people. It might have gotten him into trouble. [Clarke]

In some cases, participants expressed the beliefs that their abusive experience not only deprived them life opportunities but also opportunities to have families of their own. As Tom and Marie explain:

We were getting done for child neglect because one of our child has a disorder that means she bruise very easily. They all our four kids into care, social workers said because we had a bad childhood ourselves because I was abused by my father as well, they felt that we will fail our children because we were failed by our parents. We weren’t given any chance [Tom and Marie]

Norma, described the removal of her child to care and her maladaptive behaviour of excessive alcohol use in the same context as her experience of sexual abuse by her father.

I had two little boys with me and got took off from me and put into care. I got sexually abused by my father when I was six. So we were put into care. He abused me when I was five and raped me when I was six. Then we went into care all of us I have four brothers and four sisters. My dad did eighteen months for sexually abusing me and my sister. I thought it was normal as well I thought that is what dads do [Norma]

The analysis of participants in this study appears to suggest that social condition one is raised influence the choice of social connections and life partner. Some participants who have had experience of abuse as children had partner who had similar experience as children Tom and Marie, Lee, David and his partners all had partners who experienced child abuse as children.

Tom and Marie is a couple we interviewed together. They met in hostel for homeless people they have got four children. All four children have been removed from them and placed into care. They sleep rough along the canal. They explained:

We have been together for seven years we had a house and children social services removed children from us, we fell within bedroom tax. …we received an eviction order …on the 26th and the eviction date was the 27th while we were in family court fighting for our children. …because of my mental health …they were refusing to help us.

Our children have been adopted now. The adoption was done without our permission we didn’t agree to it because we wanted our children home because we felt we were unfairly treated and I [Marie] was left out in all this and they pin it all on you [Tom] didn’t they yeah, my [Tom] history that I was in care didn’t help.

Tom went on to talk about the condition under which he was raised:

I was abandoned by my mother when I was 12 I was then put into care; I was placed with my dad when I was 13 who physically abused me then sent back to care. [Tom].

David’s story provides another example of how social condition one is raised influence the choice of social connections and life partner. David has two children from two different women, both women grew up in care. Lisa one of David’s child mother is a second generation of children in care, her mother was raised in care too.

I drink to deal with problems. As I say I’ve got two kids with my girlfriend Kyleigh, but I got another lad with Lisa, he was taken off me by social services and put on for adoption ten years ago and that really what started it; to deal with that. Basically, because I was young, and I had been in care and the way I had been treated by my mum. Basically laid on me in the same score as my mum and because his mum [Lisa] was in care as well. So they treated us like that, which was just wrong. [David]

In this study, most participants identified alcohol or drugs and crime as the cause of relationships breakdown. However, the language they used indicates that these were secondary reasons rather than primary reasons for their homelessness. The typical question that MA and MG asked the interview participants was “tell us how did you become homeless”? Typically, participants cited different maladaptive behaviours to explain how they became homeless.

Alvin’s story is typical of:

Basically I started off as a bricklayer, … when the recession hit, there was an abundance of bricklayers so the prices went down in the bricklaying so basically with me having two young children and the only breadwinner in the family... so I had to kinda look for factory work and so I managed to get a job… somewhere else…. It was shift work like four 12 hour days, four 12 hour nights and six [days] off and stuff like that, you know, real hard shifts. My shift was starting Friday night and I’ll do Friday night, Saturday night to Monday night and then I was off Tuesday, Wednesday and Thursday, but I’d treat that like me weekend you know because I’ve worked all weekend. Then… so I’d have a drink then and stuff like that, you know. 7 o’ clock on a Monday morning not really the time to be drinking, but I used to treat it like me weekend. So we argued, me and my ex-missus [wife], a little bit and in the end we split up so moved back to me mum's, but kept on with me job, I was at me mum’s for possibly about five years and but gradually the drinking got worse and worse, really bad. I was diagnosed with depression and anxiety. … I used to drink to get rid of the anxiety and also to numb the pain of the breakup of me marriage really, you know it wasn’t good, you know. One thing led to another and I just couldn’t stop me alcohol. I mean I’ve done drugs you know, I was into the rave scene and I’ve never done hard drugs like heroin or... I smoke cannabis and I use cocaine, and I used to go for a pint with me mates and that. It all came to a head about November/December time, you know it was like I either stop drinking or I had to move out of me mum's. I lost me job in the January through being over the limit in work from the night before uum so one thing led to another and I just had to leave. [Alvin]

Similarly, Gary identified alcohol as the main cause of his relationship breakdown. However, when one listens to the full story alcohol appears to be a manifestation of other issues, including financial insecurities and insecure attachment etc.

It [the process of becoming homeless] mainly started with the breakdown of the relationship with me partner. I was with her for 15 years and we always had somewhere to live but we didn't have kids till about 13 years into the relationship. The last two years when the kids come along, I had an injury to me ankle which stopped me from working. I was at home all day everyday. …I was drinking because I was bored. I started drinking a lot ‘cause I couldn't move bout the house. It was a really bad injury I had to me ankle. Um, and one day me and me partner were having this argument and I turned round and saw my little boy just stood there stiff as a board just staring, looking at us. And from that day on I just said to me partner that I'll move out, ‘cause I didn't want me little boy to be seeing this all the time. [Gary]

In both cases Gary and Alvin indicate that changes in their employment status created conditions that promoted alcohol dependency, though both explained that they drank alcohol before the changes in their employment status occurred and the breakdown of relationships. Both intimated that that their job commitment limited the amount of time available to drink alcohol. As Gary explained, it is the frequency and amount of alcohol drinking that changed as a result of change in their employment status:

I used to have a bit of a drink, but it wasn’t a problem because I used to get up in the morning and go out to work and enjoy a couple of beers every evening after a day’s work. Um, but then when I wasn't working I was drinking, and it just snowballed out, you know snowball effect, having four cans every evening and then it went from there. I was drinking more ‘cause I was depressed. I was very active before and then I became like non-active, not being able to do anything and in a lot of pain as well. [Gary]

Furthermore, although the participants claim that drinking alcohol was not a problem until their employment circumstances changed, one gets a sense that alcohol was partly responsible for creating conditions that resulted in the loss of their jobs. In Gary’s case, for example, alcohol increased his vulnerability to the assault and injuries that cost him his job:

I got assaulted, kicked down a flight of stairs. I landed on me back on the bottom of the stairs, but me heel hit the stairs as it was still going up if you know what I mean. Smashed me heel, fractured me heel… So, by the time I got to the hospital and they x-rayed it they wasn't even able to operate ‘cause it was in that many pieces, they weren't even able to pin it if you know what I mean. [Gary]

Alvin, of the other hand, explained that:

I lost my job in the January through being over the limit in work from the night before, uum so one thing led to another and I just had to leave. [Alvin]

In all cases participants appear to construct marriage breakdown as an exacerbating factor for their alcohol dependence. Danny, for example, constructed marriage breakdown as a condition that created his alcohol dependence and alcohol dependence as a cause of breakdown of his relationship with his parents. He explains:

I left school when I was 16. Straight away I got married, had children. I have three children and marriage was fine. Umm, I was married for 17 years. As the marriage broke up I turned to alcohol and it really, really got out of control. I moved in with my parents... It was unfair for them to put up with me; you know um in which I became... I ended up on the streets, this was about when I was 30, 31, something like that and ever since it's just been a real struggle to get some permanent accommodation. [Danny]

Danny goes on to explain:

Yes [I drank alcohol before marriage broke down but] not very heavily, just like a sociable drink after work. I'd call into like the local pub and have a few pints and it was controlled. My drinking habit was controlled then. I did go back to my parents after my marriage break up, yes. I was drinking quite heavily then. I suppose it was a form of release, you know, in terms of the alcohol which I wish I'd never had now. When I did start drinking heavy at me parents’ house, I was getting in trouble with the police being drunk and disorderly. That was unfair on them. [Danny]

The data in this study indicate that homelessness occurs when the relationships collapse, irrespective of the nature of the relationship. There were several cases where lifestyle behaviour led to a relationship collapse between child and parents or legal guardians.

In the next excerpt, Emily outlines the incidents: smoking weed, doing crack and heroin, and drinking alcohol. She also uses the words ‘because’, ‘when’ and ‘obviously’, which provide clues about the precipitating condition for her behaviours “spending long time with people who take drugs”.

I've got ADHD like, so obviously my mum kicked me out when I was 17 and then like I went to **Beswick** and stuff like that. My mum in the end just let me do what I wanted to do, ‘cause she couldn't cope anymore. …I mean I tried to run away from home before that, but she'd always like come after me in like her nightie and pyjamas and all that. But in the end she just washed her hands of me . [Emily]

Emily presented a complex factors that made it difficult for her mother to live with her. These included her mother struggle with raising four kids as a single parent, Emily’s mental health (ADHD], alcohol and drug use. She goes on to explain that:

Ummm, well the reason I got kicked out of my hostel was ‘cause of me drinking, so I'd get notice to quit every month, then I’d have a meeting with the main boss and then they'd overturn it and this went on every month for about six months. Also, it was me behaviour as well, but obviously drink makes you do stuff you don't normally do and all that shit. I lived here for six months, got kicked out because I jumped out the window and broke me foot. I was on the streets for six months and then they gave me a second chance and I've been here a year now. So that's it basically. [Emily]

There were several stories of being evicted from accommodation due to excessive use of alcohol. One of those is David:

I got put into foster care. When I left foster care I was put in the hostel, from there I turn into alcoholic. Then I was homeless all the time because I got kicked out of the hostels, because you are not allowed to drink in the hostel. It’s been going on now for about… I was thirty-one on Wednesday, so it’s been going on for about thirteen years, homeless on and off. Otherwise if not having shoplifted for food and then go to jail, and when I don’t drink I have lot of seizures and I end up in the hospital. Every time I end up on the street. I trained as a chef, I have not qualified yet, because of alcohol addiction, it didn’t go very well. I did couple of jobs in restaurants and diners, I got caught taking a drink. [David]

Contrary to the other incidents where alcohol was a factor that led to homelessness, Barry’s description of his story appears to suggest that the reason he had to leave his parents’ home was his parents’ perception that his sexuality brought shame to the family:

When I came out they I’m gay, my mum and dad said you can’t live here anymore. I lived in a wonderful place called Nordic... but fortunately, mum and dad ran a pub called […] [and] one of the next door neighbours lived in a mansion. His name was [….] [and] when I came out, he came out as in he said “I'm a gay guy”, but he took me into Liverpool and housed me because I had nowhere to live. My mum and dad said you can't live here anymore. And unfortunately, we get to the present day. I got attacked. I got mugged... only walked away with a £5 note, it’s all they could get off me. They nearly kicked me to death so I was in hospital for three weeks. By the time I came out, I got evicted from my flat. I was made homeless. [Barry]

We used the phrase “engaging in maladaptive behaviour” to conceptualise the behaviours that led to the loss of accommodation because our analysis appear to suggest that these behaviours were strategies to cope with the conditions they found themselves in. For example, all participants in this category explained that they drank alcohol to cope with multiple health (mental health) and social challenges.

In the UK adulthood homelessness is more visible than childhood homelessness. However, most participants in this research reveal that the process of becoming homeless begins at their childhood, but becomes visible after the legal age of consent (16). Participants described long history of trouble with people in authority including parents, legal guardians and teachers. However, at the age of 16 they gain legal powers to leave children homes, foster homes, parental homes and schools, and move outside some of the childhood legal protections. Their act of defiance becomes subject to interdiction by the criminal justice system. This is reflected in number of convictions for criminal offenses some of the participants in this study had.

Participants Ruddle, David, Lee, Emily, Pat, Marco, Henry and many other participants in this study (see Table 1 ) clearly traced the beginning of their troubles with authority back at school. They all expressed the belief that had their schooling experience been more supportive, their lives would have been different. Lee explains that being in trouble with the authorities began while he was at school:

‘The school I came from a rough school, it was a main school, it consisted of A, B, C, D and The school I came from [was] a rough school, it was a main school, it consisted of A, B, C, D and E. I was in the lowest set, I was in E because of my English and maths. I was not interested, I was more interested in going outside with big lads smoking weed, bunking school. I used to bunk school inside school. I used to bunk where all cameras can catch me. They caught me and reported me back to my parents. My mum had a phone call from school asking where your son is. My mum grounded me. While my mum grounded me I had a drain pipe outside my house, I climbed down the drain pipe outside my bedroom window. I used to climb back inside. [Lee]

Lee’s stories constructed his poor education experiences as a prime mover towards the process of becoming homeless. It could be noted in Table 1 that most participants who described poor education experiences came from institutions such as foster care, children home and special school for maladjusted children. These participants made a clear connection between their experiences of poor education characterised by defiance of authorities and poor life outcomes as manifested through homelessness.

Patrick made a distinct link between his school experience and his homelessness, for example, when asked to tell his story leading up to becoming homeless, Patrick’s response was:

I did not go to school because I kept on bunking. When I was fifteen I left school because I was caught robbing. The police took me home and my mum told me you’re not going back to school again, you are now off for good. Because if you go back to school you keep on thieving, she said I keep away from them lads. I said fair enough. When I was seventeen I got run over by a car. [Patrick]

Henry traces the beginning of his troubles with authorities back at school:

[My schooling experience]… was good, I got good, well average grades, until I got myself into [a] few fights mainly for self-defence. In primary schools, I had a pretty... I had a good report card. In the start of high school, it was good and then when the fights started that gave me sort of like a... bad reputation. I remember my principal one time made me cry. Actually made me cry, but eh... I don't know how, but I remember sitting there in the office and I was crying. My sister also stuck up for me when she found out what had happened, she was on my side; but I can’t remember exactly what happened at that time. [Henry]

Emily’s story provides some clues about the series of incidents - including, delay in diagnosing her health condition, being labelled as a naughty child at school, being regularly suspended from school and consequently poor educational attainment.

Obviously, I wasn't diagnosed with ADHD till I was like 13, so like in school they used to say that's just a naughty child. … So it was like always getting suspended, excluded and all that sort of stuff. And in the end [I] went to college and the same happened there. [Emily]

The excerpt above provides intimations of what she considers to be the underlying cause of her behaviour towards the authorities. Emily suggests that had the authorities taken appropriate intervention to address her condition, her life outcomes would have been different.

Although the next participant did not construct school as being a prime mover of their trouble with authorities, their serious encounters with the criminal justice system occurred shortly after leaving school:

Well I did a bit of time at a very early age, I was only 16… I did some remand there, but then when I went to court ‘cause I'd done enough remand, I got let out and went to YMCA in Runcorn. Well, that was when I was a kid. When I was a bit older, ‘cause it was the years 2000 that I was in jail, I was just trying to get by really. I wasn’t with Karen at the time. I was living in Crewe and at the time I was taking a lot of amphetamines and was selling amphetamines as well, and I got caught and got a custodial sentence for it. But I've never been back to jail since. I came out in the year 2000 so it's like 16 years I've kept meself away from jail and I don't have any intentions of going back. [Gary]

The move from school and children social care system to criminal justice was a common pathways for many participants in this study. Some including Lee, Crewe, David, Patrick spent multiple prison sentences (see Table 1 ). Although Crewe did not make connection between his schooling experiences and his trouble with law, it could be noted that his serious encounter with criminal justice system started shortly after leaving foster care and schooling systems. As he explains:

I was put into prison at age of 17 for arson that was a cry for help to get away from the family, I came out after nine months. I have been in prison four times in my life, its not very nice, when I came out I made a promise to myself that I’m never going to go back to prison again. [Crewe]

Lee recalls his education experience. He explained:

I left school when I was fifteen… then I went off the rails. I got kidnapped for three and half months. When I came back I was just more interested in crime. When I left school I was supposed to go to college, but I went with travellers. I was just more interested in getting arrested every weekend, until my mum say right I have enough of you. I was only seventeen. I went through the hostels when I was seventeen. [Lee]

None describe the educational experience with a similar profundity to Marco:

On few occasions I came out on the corridors I would be getting battered on to my hands and knees and teachers walk pass me. There was quite often blood on the floor from my nose, would be punched on my face and be thrown on the floor. …. It was hard school, pernicious. I would go as far as saying I never felt welcome in that school, I felt like a fish out of the water, being persistently bullied did my head in. Eventually I started striking back, when I started striking back suddenly I was a bad one. My mother decided to put me in … school for maladjusted boys, everyone who been there including myself have spent time in prison. [Marco]

The trouble with authorities that was observes in participants stories in this category appear to be part of the wider adverse social challenges that the participants in this study were facing. Crewe’s description of arson as a cry for help appears to be an appropriate summation of all participants in this category.

The participants’ description of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

The key feature that distinguish this study from comparable previous studies is that it openly acknowledges that data collection and analysis were influenced by the principles of social justice [ 28 , 30 , 31 ]. The resulting theoretical explanation therefore constitutes our interpretation of the meanings that participants ascribe to their own situations and actions in their contexts. In this study, defining homelessness within the wider socioeconomic context seemed to fit the data, and offered one interpretation of the process of becoming homeless.

While the participants’ experiences leading to becoming homeless may sound trite. What is pertinent in this study is understanding the conditions within which their behaviours occurred. The data were examined through the lens of social justice and socio-economic inequalities: we analysed the social context within which these behaviours occurred. We listened to accounts of their schooling experiences, how they were raised and their social network. The intention was not to propose a cause-and-effect association, but to suggest that interventions to mitigate homelessness should consider the social conditions within which it occurred.

Participants in this study identified substance misuse and alcohol dependency as a main cause of their homelessness. These findings are consistent with several epidemiological studies that reported a prevalence of substance misuse amongst the homeless people [ 32 , 33 , 34 , 35 , 36 ]. However, most these studies are epidemiological; and by nature epidemiological studies are the ‘gold standard’ in determining causes and effects, but do not always examine the context within which the cause and effect occur. One qualitative study that explored homelessness was a Canadian study by Watson, Crawley and Cane [ 37 ]. Participants in the Watson, et al. described ‘lack of quality social interactions and pain of addition. However, Watson et al. focus on the experiences of being homeless, rather than the life experiences leading to becoming homeless. To our knowledge the current study is one of very few that specifically examine the conditions within which homelessness occurs, looking beyond the behavioural factors. Based on the synthesis of data from previous studies, it makes sense that many interventions to mitigate homelessness focus more on tackling behavioural causes of homelessness rather than fundamental determinants of it [ 38 ]. From the public health intervention’ point of view, however, understanding the conditions within which homelessness occurs is essential, as it will encourage policymakers and providers of the services for homelessness people to devote equal attention to tackling the fundamental determinants of homelessness as is granted in dealing behavioural causes.

Participants in this study reported that they have been defiant toward people in positions of authority. For most of them this trouble began when they were at school, and came to the attention of the criminal justice system as soon as they left school at the age of 16. These findings are similar to these in the survey conducted by Williams, Poyser, and Hopkins [ 39 ] which was commissioned by the UK Ministry of Justice. This survey found that 15 % of prisoners in the sample reported being homeless before custody [ 39 ]; while three and a half percent of the general population reported having ever been homeless [ 39 ]. As the current study reveals there are three possible explanations for the increased population of homeless young people in the criminal justice system: first, at the age of 16 they gain legal powers to leave their foster homes, parents homes, and schools and move beyond some of the childhood legal protections; second, prior to the age of 16 their defiant behaviours were controlled and contained by schools and parents/legal guardians; and third, after the age of 16 their acts of defiant behaviour become subject to interdiction by the criminal justice system.

The conditions in which they were born and raised were described by some participants in this study as ‘chaotic’, abusive’, ‘neglect’, ‘pernicious’ ‘familial instability’, ‘foster care’, ‘care home’, etc. Taking these conditions, and the fact that all but one participants in this left school at or before the age of 16 signifies the importance of living conditions in educational achievement. It has been reported in previous studies that children growing up in such conditions struggle to adjust in school and present with behavioural problems, and thus, poor academic performance [ 40 ]. It has also been reported that despite these families often being known to social services, criminal justice systems and education providers, the interventions in place do little to prevent homelessness [ 40 ].

Analysis of the conditions within which participants’ homelessness occurred reveals the adverse social conditions within which they were born and raised. The conditions they described included being in an abusive environment, poor education, poor employment or unemployment, poor social connections and low social cohesion. These conditions are consistent with high index of poverty [ 37 , 41 , 42 ]. And several other studies found similar associations between poverty and homelessness [ 42 ]. For example, the study by Watson, Crowley et al. [ 37 ] found that there were extreme levels of poverty and social exclusion amongst homeless people. Contrary to previous studies that appear to construct homelessness as a major form of social exclusion, the analysis of participants’ stories in this current study revealed that the conditions they were raised under limited their capacity to engage in meaningful social interactions, thus creating social exclusion.

Homeless people describe the immediate behavioural causes of homelessness; however, this analysis revealed the social and economic conditions within which homelessness occurred. The participants’ descriptions of the social conditions in which were raised and their references to maladaptive behaviours which led to them becoming homeless, led us to conclude that they believe that their social condition affected their life chances: that these conditions were responsible for their low quality of social connections, poor educational attainment, insecure employment and other reduced life opportunities available to them.

Limitations

The conclusions drawn relate only to the social and economic context of the participants in this study, and therefore may not be generalised to the wider population; nor can they be immediately applied in a different context. It has to be acknowledged that the method of recruitment of the 26 participants generates a bias in favour of those willing to talk. The methodology used in this study (constructivist grounded theory) advocates mutual construction of knowledge, which means that the researchers’ understanding and interpretations may have had some influence on the research process as the researchers are an integral part of the data collection and analysis

Department for Communities and Local Government. Statutory homelessness: October to December quarter 2015, in 26 homelessness statistical release 2016. London: Stationery Office; 2015.

Google Scholar  

HM Government. Homelessness act 2002. London: UK Government; 2002.

HM Government. Homelessness reduction act 2017. London: UK government; 2017.

MH Government. Housing (Homeless Persons) act 1977. London: UK Government; 1977.

Department for Communities and Local Government. Statutory homelessness: October to December quarter 2015, in 26 homelessness statistical release 2016. London: Stationery Office; 2016.

Christian J, Abrams D, Clapham D, Nayyar D, Cotler J. Intentions to move from homelessness to social inclusion: the role of participation beliefs, attitudes and prior behaviour. Soc Incl. 2016;4643(4):16–27.

Article   Google Scholar  

Deforge BR, Belcher J, O’rourke M, Lindsey MA. Personal resources and homelessness in early life: predictors of depression in consumers of homeless multiservice centres. J Loss Trauma. 2008;13:222–42.

Barman-Adhikari A, Petering R, Lengnick-Hall R, Rice E, Rhoades H, McCune S. Social context of service use among homeless youth in Los Angeles, California. J Soc Serv Res. 2016;42(4):501–15.

Barman-Adhikari A, Bowen E, Bender K, Brown S, Rice E. A social capital approach to identifying correlates of perceived social support among homeless youth. Child Youth Care Forum. 2016;45(5):691–708.

Keane CA, Magee CA, Kelly PJ. Is there a complex trauma experience typology for Australians experiencing extreme social disadvantage and low housing stability? Child Abuse Negl. 2016;61:43–54.

Article   PubMed   Google Scholar  

Department for Communities and Local Government. The English indices of deprivation 2015. London: Stationery Office; 2016.

Patterson ML, Moniruzzaman A, Somers JM. History of foster care among homeless adults with mental illness in Vancouver, British Columbia: a precursor to trajectories of risk. BMC Psychiatry. 2015;15(1):32.

Article   PubMed   PubMed Central   Google Scholar  

Fry C, Langley K, Shelton K. A systematic review of cognitive functioning among young people who have experienced homelessness, foster care and of poverty. Child Neuropsychol. 2016; doi.10.1080/09297049.2016.1207758 .

Reeve K. Welfare conditionality, benefit sanctions and homelessness in the UK: ending the ‘something for nothing culture’ or punishing the poor? J Poverty Soc Justice. 2017;25(1):65–78.

Somers J, Patterson M, Moniruzzaman A, Currie L, Rezansoff S, Palepu A. Vancouver at home: pragmatic randomized trials investigating housing first for homeless and mentally ill adults. Trials. 2013. doi: 10.1186/1745-6215-14-365 .

Watson J, Crawley J, Kane D. Social exclusion, health and hidden homelessness. Public Health. 2016;139:96–102.

Article   CAS   PubMed   Google Scholar  

Roos LE, Distasio J, Bolton S-L, Katz LY, Afifi TO, Isaak C, Goering P, Bruce L, Sareen J. A history in-care predicts unique characteristics in a homeless population with mental illness. Child Abuse Negl. 2014;38(10):1618–27.

Anderson I, Christian J. Causes of homelessness in the UK: a dynamic analysis. J Community Appl Soc Psychol. 2003;13:105–18.

Anderson I. Synthesizing homelessness research: trends, lessons and prospects. J Community Appl Soc Psychol. 2003;13:197–205.

Tsai J, Edens EL, Rosenheck RA. A typology of childhood problems among chronically homeless adults and its association with housing and clinical outcomes. J Health Care Poor Underserved. 2011;22(3):853–70.

Haskett ME, Armstrong MJ, Tinsdale J. Developmental status and social-emotional functioning of young children experiencing homelessness. Early Childhood Educ J. 2016;44:119–25.

Charmaz K. Constructing grounded theory: a practical guide through qualitative analysis. London: SAGE Publications; 2006.

Glaser BG. Remodelling grounded theory. Hist Soc Res. 2007;Supplement 19:47–68.

Corbin J, Strauss A. Basics of qualitative research: techniques and procedures for developing grounded theory. Los Angeles: Sage Publications; 2008.

Book   Google Scholar  

Economic and Social Research Council: The research ethics guidebook a resource for social scientists. 2017. http://www.ethicsguidebook.ac.uk/ . Accessed 6 June 2017.

HM Government: Mental capacity act 2005.2005. http://www.legislation.gov.uk/ukpga/2005/9/pdfs/ukpga_20050009_en.pdf . Accessed 5 June 2017.

Strauss A, Corbin J. Basics of qualitative research: techniques and procedures for developing grounded theory. 2nd ed. London: Sage Publication; 1998.

Mabhala M. Public health nurse educators’ conceptualisation of public health as a strategy to reduce health inequalities: a qualitative study. Int J Equity Health. 2015;14:14.

Mabhala MA, Massey A, Ellahi B, Kingston P. Understanding the determinants of homelessness through examining the life stories of homeless people and those who work with them: a qualitative research protocol. Diversity Equality Health Care. 2016;13(4):284–9.

Mabhala M. Social justice and global perspectives on health improvement in health improvement and wellbeing strategies and actions. Maidenhead: McGrow Hill and Open University Press; 2014.

Mabhala MA. Health inequalities as a foundation for embodying knowledge within public health teaching: a qualitative study. Int J Equity Health. 2013;12:46.

North CS, Eyrich-Garg KM, Pollio DE, Thirthalli J. A prospective study of substance use and housing stability in a homeless population. Soc Psychiatric Epidemiol. 2010;45:1055–62.

Kushel M, Vittinghoff E, Haas J. Factors associated with the health care utilization of homeless persons. J Am Med Assoc. 2001;285:200–6.

Article   CAS   Google Scholar  

Orwin RG, Scott CK, Arieira C. Transitions through homelessness and factors that predict them: three-year treatment outcomes. J Subst Abus Treat. 2005;28:S23–39.

Grinman MN, Chiu S, Redelmeier DA, Levinson W, Kiss A, Tolomiczenko G, Cowan L, Hwang SW. Drug problems among homeless individuals in Toronto, Canada: prevalence, drugs of choice, and relation to health status. BMC Public Health. 2010;10:94.

Linton SL, Celentano DD, Kirk GD, Mehta SH. The longitudinal association between homelessness, injection drug use, and injection-related risk behaviour among persons with a history of injection drug use in Baltimore, MD. Drug Alcohol Depend. 2013;132:457–65.

Crawley J, Kane D, Atkinson-Plato L, Hamilton M, Dobson K, Watson J. Needs of the hidden homeless – no longer hidden: a pilot study. Public Health. 2013;27(7): 674–80.

Office of the Deputy Prime Minister: Housing, planning, and local government and the regions committee: homelessness: third report of session 2004–05. 2005. https://www.publications.parliament.uk/pa/cm200405/cmselect/cmodpm/61/61i.pdf . Accessed 24 Oct 2016.

Williams K, Poyser J, Hopkins K. Accommodation, homelessness and reoffending of prisoners: results from the surveying prisoner crime reduction (SPCR) survey. London: Ministry of Justice; 2012.

Kennedy S. It should not be a pit stop: voices and perspectives of homeless youth on labeling and placement in special education. J Ment Health Res Intellect Disabil. 2017;10:1–19.

Lugo MA. Oxford Poverty & Human Development Initiative (OPHI): employment, in Oxford Poverty & Human Development Initiative (OPHI). Oxford: Oxford University; 2007.

Shinn M. Homelessness, poverty and social exclusion in the United States and Europe. Eur J Homelessness. 2010;4:19–43.

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Acknowledgements

The authors wish to thank all participants in this study; without their contribution it would not have been possible to undertake the research. The authors acknowledge the contribution of Professor Paul Kingston and Professor Basma Ellahi at the proposal stage of this project. A very special thanks to Robert Whitehall, John and all the staff at the centres for homeless people for their help in creating a conducive environment for this study to take place; and to Roger Whiteley for editorial support. A very special gratitude goes to the reviewers of this paper, who will have expended considerable effort on our behalf. 

This research was funded by quality-related research (QR) funding allocation for the University of Chester.

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The datasets generated during and/or analysed during the current study are not publicly available due to ethical restriction and privacy of participant data but are available from the corresponding author on reasonable request.

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MM wrote the entire manuscript, designed the study, collected data, analysed and interpreted data, and presented the findings. AY contributed to transcribing data and manuscript editing. MG contributed to data collection, and transcribed the majority of data. All authors read and approved the final manuscript.

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Mabhala, M.A., Yohannes, A. & Griffith, M. Social conditions of becoming homelessness: qualitative analysis of life stories of homeless peoples. Int J Equity Health 16 , 150 (2017). https://doi.org/10.1186/s12939-017-0646-3

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But homeless populations arguably are one of the most difficult populations to study, because they are often transient, lack consistent contact information, and may not want to identify themselves as homeless. For this reason, one of the most valuable types of research on homelessness is actually research about research.

Confused? Allow me to explain. The value of research is dependent on the way researchers go about conducting it (i.e. its methodology). The better the methodology of the research, the more useful the researcher’s findings will be, both for policymakers and other researchers. So it’s really important that researchers develop strong methodologies.

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Studies like these are important in our quest to conduct more and better research on homelessness. As research continues improve and grow, our advocates will be better able to fight for the funding and services necessary to end homelessness.

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