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Homelessness in America

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This handbook was prepared by Nell McGarity, Allison Conyers, and MaryCunningham of the Homelessness Research Institute at the National Alliance toEnd Homelessness. We would like to thank the journalists and communicatorswho offered assistance with this guide:

■ Buck Baggot, Consultant■ Amrit Dillion, National Low Income Housing Coalition■ Kevin Fagan, San Francisco Chronicle■ Henry Griggs, Center on Budget and Policy Priorities■ Lyn Hikida, Corporation for Supportive Housing■ Douglas McGray, Freelance Journalist■ Cheryl Weitzstein, The Washington Times■ Mary Otto, The Washington Post

The authors take full responsibility for this product, and the contributors andlisted experts should not be viewed as endorsing this material. All errors oromissions are the responsibility of the authors.

The National Alliance to End Homelessness is a nonpartisan, mission-drivenorganization committed to preventing and ending homelessness in the UnitedStates.

Our WorkThe National Alliance to End Homelessness is a leading voice on the issue ofhomelessness. The Alliance analyzes policy and develops pragmatic, cost-effectivepolicy solutions. We work collaboratively with the public, private, and nonprofitsectors to build state and local capacity, leading to stronger programs and poli-cies that help homeless individuals and families make positive changes in theirlives. We provide data and research to policymakers and elected officials in orderto inform policy debates and educate the public and opinion leaders nationwide.


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ContentsIntroduction 1

Homelessness by the Numbers 2

Family Homelessness 6

Homeless Adults 8

Rural Homelessness 9

Youth Homelessness 11

Veterans 12

Prisoner Reentry 14

Domestic Violence 15

Mental and Physical Health and Substance Abuse 16

Frequently Asked Questions 18How Much Does the Federal Government Spend on Homelessness? 18

What Is Housing First? 19

What Is Permanent Supportive Housing? 19

What Is the Ten Year Plan? How Many Local Ten Year Plans Exist? 20

Endnotes 20


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IntroductionHomelessness is one of our nation’s most misunderstood and vexing social prob-lems. Because homelessness is complex, it is often difficult for the media to coverthe issue with the background and nuance necessary to capture the full picture,particularly for stories that are time sensitive. Events that affect individuals orfamilies who are homeless or at risk of homelessness may arise quickly andrequire immediate action to track down background, relevant sources, andexperts. Quantitative data are often disjointed, expansive, or difficult to find andprocess in a short amount of time. This guide aims to streamline this process byproviding context and reliable sources for reporters to access quickly.

The goal of this guide is to stimulate thoughtful and insightful reporting on a pop-ulation that is often poorly understood. While typical stories on homelessnessoften involve local panhandling ordinances or deaths of homeless people causedby extreme weather—valued coverage that brings attention to the issue—thesestories can be developed further into examinations of what strategies are effectivein ending homelessness, how communities can better address the needs of theirhomeless population, or how future homelessness can be prevented. In this guide,we present homelessness issues by population. We hope that by providing quickfacts, background, and a listing of the most knowledgeable experts, more enrichingand informative reporting will result.

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Homelessness by the NumbersThe most common question about homelessness is how many people are currentlyhomeless. Prior to this year, the last nationwide estimate of the number of home-less people—the National Survey of Homeless Assistance Providers and Clients(NSHAPC)—was taken over 10 years ago in 1996. The research was sponsored bythe Interagency Council on Homelessness and conducted by the Urban Institute.The study found that between 444,000 and 842,000 people in the United States werehomeless. This estimate provides data on how many people are homeless at a spe-

cific point in time. However, the reality isthat the homeless population is quitefluid—people move in and out of home-lessness and most people are homeless foronly a short period of time. To create anannual estimate of how many peopleexperience homelessness, researchersextrapolated this number, finding thatbetween 2.3 and 3.5 million people peryear experience homelessness.1 Recently,the National Alliance to End Home -lessness compiled data from counts oflocal homeless populations. This studyfound that approximately 750,000 peoplewere homeless on any given night inJanuary 2005.2

2

Resources National Alliance to End Homelessness

www.endhomelessness.orgThe Urban Institute

www.urban.orgThe 1996 National Survey of Homeless

Assistance Providers and Clientswww.huduser.org/publications/homeless/homeless_tech.html

Expert Sources Martha Burt, Urban InstituteDennis Culhane, University of

PennsylvaniaJill Khadduri, Abt AssociatesNan Roman, National Alliance to End

Homelessness


3

Homelessnessby theNumbers

FamilyHomelessness

HomelessAdults

Martha Burt,Urban Institute

Dennis Culhane,University ofPennsylvania

Jill Khadduri,Abt Associates

Nan Roman,National Allianceto EndHomelessness

Ellen Bassuk,National Centeron FamilyHomelessness

Sheila Crowley,National LowIncome HousingCoalition

Debra Rog,Westat


Marybeth Shinn,New YorkUniversity

Dennis Culhane,University ofPennsylvania


Carol Wilkens,Corporation forSupportiveHousing

Prior to this year, the last nationwide estimate of the number of homeless people—the National Survey of Homeless Assistance Pro -viders and Clients (NSHAPC)—was taken over 10 years ago in 1996.

The study found that between 444,000 to 842,000 people in the United States were homeless at any point in time. A recent study bythe National Alliance to End Homelessness found that about 750,000experienced homelessness in January 2005. These estimates providedata on how many people are homeless at a specific point in time.

However, the reality is that the homeless population is quitefluid—people move in and out of homelessness and most peo-ple are homeless for only a short period of time.

To create an annual estimate of homelessness, researchersextrapolated the 1996 estimate, finding between 2.3 and 3.5 million people per year experience homelessness.

Every year 600,000 families with 1.35 million children experi-ence homelessness in the United States.

The existing—and most conclusive—research identifies the lackof affordable housing as the primary cause of homelessnessamong families in the United States.

Studies have shown that families exiting homelessness with ahousing subsidy remain stably housed over time; they are 21times more likely to remain stably housed than comparablefamilies exiting a shelter without a subsidy.

Without a housing subsidy a family has to make $16.31 an hour($33,942.80 annually) to afford housing at the national fair mar-ket rent; the hourly rate is much higher in higher-cost rentalmarkets, such as Washington, DC; Boston, Massachusetts; andAlameda County, California.

An overwhelming majority (80 percent) of single adult shelterusers enters the homeless system only once or twice, stay justover a month, and do not return.

Approximately 9 percent enter nearly five times a year and staynearly two months each time. This group utilizes 18 percent ofthe system’s resources.

The remaining 10 percent enters the system just over twice ayear and spends an average of 280 days per stay—virtually liv-ing in the system and utilizing nearly half its resources. Many ofthese individuals are defined as chronically homeless.

There are approximately 150,000 to 200,000 chronically home-less individuals nationwide.

Issue ExpertsAt a Glance

Homelessness at a Glance


4

RuralHomelessness

YouthHomelessness

HomelessVeterans

PrisonerReentry

Martha Burt,Urban Institute



Paul Toro,Wayne StateUniversity

Cheryl Beversdorf,National Coalitionfor HomelessVeterans


Robert Rosenheck,Yale MedicalSchool

Caterina GouvisRoman, Urban Institute


The exact number of people who experience rural homelessnessis unknown, but the last national count of homeless peoplefound that 9 percent live in rural areas.

Many rural homeless people live in places we do not see; they often are sleeping in the woods, campgrounds, cars,abandoned farm buildings, or other places not intended forhabitation.

Many more individuals and families in rural areas live in sub-standard housing or are doubled-up. These households are atrisk of homelessness.

Although the prevalence of youth homelessness is difficult tomeasure, researchers estimate that about 5 to 7.7 percent ofyouth experience homelessness each year.

The same factors that contribute to adult homelessness, suchas poverty, lack of affordable housing, low education levels,unemployment, mental health, and substance abuse, can leadto homelessness among youths.

Youths transitioning out of foster care are at high-risk of becoming homeless. Every year between 20,000 and 25,000youths ages 18 and older age out of the foster care system.

Convergent sources estimate that between 23 and 40 percent ofhomeless adults are veterans, which matches the proportion ofveterans in the overall U.S. population.

The veterans are of different wars and conflicts, includingWorld War II, Korean War, Cold War, Vietnam War, Grenada,Panama, and Lebanon; research indicates that those serving inthe late-Vietnam and post-Vietnam era are at greatest risk ofhomelessness.

Recent media accounts highlight a small but growing trend ofveterans from Iraq showing up in shelters; however, there hasbeen no rigorous study documenting this phenomenon.

Each year, more than 650,000 people are released from stateprisons in the United States, and an estimated 12 million are released from jails.

More than 10 percent of those coming in and out of prisons andjail are homeless in the months before their incarceration.

Shelter use, both before incarceration and after release, is associated with an increased risk of return to prison: in a studyof 50,000 individuals who were released from New York Stateprisons and returned to New York City between 1995 and 1998,the risk of reincarceration increased 23 percent with prereleaseshelter stay, and 17 percent with postrelease shelter stay.




5

DomesticViolence

Mental andPhysicalHealth

Ellen Bassuk,National Centeron FamilyHomelessness


Arturo Bendixen,AIDS Foundationof Chicago

Nancy Bernstine,National AIDSHousing Coalition

Jim O’Connell,Boston Healthcarefor the Homeless


Robert Rosenheck,Yale MedicalSchool

In a national survey of homeless people, domestic violence wasthe second most frequently stated cause of homelessness forfamilies, with 13 percent of homeless families saying that theyhad left their last place of residence because of abuse or vio-lence in the household.

Domestic violence victims are often isolated from support net-works and financial resources by their abusers. As a result theymay lack steady income, employment history, credit history,and landlord references. Women survivors of physical assaultalso often suffer from anxiety, panic disorder, major depres-sion, and substance abuse.

An adequate supply of affordable housing is critical to ensuringsurvivors of domestic violence can afford to leave the sheltersystem as quickly as possible without returning to their abuser.

In a national study, 46 percent of the homeless respondentshad an alcohol use problem during the past year, and 62 per-cent had an alcohol use problem at some point in their life-time. Thirty-eight percent had a problem with drug use duringthe past year, and 58 percent had a drug use problem duringtheir lifetime.

46 percent of homeless people had one or more chronic healthconditions and 26 percent had one or more acute infectiouscondition.

The majority of homeless people (55 percent) did not have med-ical insurance of any kind.

About 25 percent of the homelessness population had seriousmental illness.



* You can find the complete citation to the facts listed in this table in their respective chapter.

* To interview these experts, please contact their organizations.


Every year 600,000 families with 1.35 million children experience homelessness inthe United States, making up about 50 percent of the homeless population overthe course of the year.3 Homeless families, mothers, fathers, grandparents, andchildren are scattered across the country. Families experiencing homelessness livein urban, suburban, and rural areas, sleeping in shelters, cars, motels, and aban-doned buildings.

The existing—and most conclusive—research identifies the lack of affordablehousing as the primary cause of homelessness among families in the UnitedStates.4 This is both because there is an inadequate supply of affordable housingand because incomes are so low that families cannot pay for the housing that isavailable. The rising cost of housing, accompanied by declining wages, createsconditions that put families at risk of losing their housing and makes it even moredifficult for families to find housing once they become homeless.5

The threat of homelessness looms constantly over most poor families who strug-gle to meet their rent or mortgage payments, but there are risk factors or pre-dictors of homelessness that suggest that some families affected by the afford-able housing crisis are more likely to become homeless than others. Familiesthat become homeless tend to share certain characteristics: they have extremelylow incomes, tend to have young children and be headed by a younger parent,lack strong social networks, and often have poor housing histories or move fre-quently.6 That said, homeless families are, in many ways, very similar to otherpoor families who do not become homeless. Both housed and homeless poorfamilies have the same (albeit high) incidences of domestic violence and similarrates of mental illness.7 Both poor housed children and homeless children sufferfrom high rates of anxiety, depression, behavioral problems, or below-averageschool performance.8 It seems that homeless families are a subgroup of poor

6

Family Homelessness


families that, for either an economic or apersonal crisis, have lost their housingand cannot get back into the housingmarket.

Studies have shown that families exiting

homelessness with a housing subsidy

remain stably housed over time; they are

21 times more likely to remain stably

housed than comparable families exiting

a shelter without a subsidy.9 However, at

current funding levels, federal programs

cannot close the gap between those who

can afford housing and those who can-

not. Today, approximately 5 million

households receive federal assistance to

help pay for housing— mostly in the form

of Section 8 housing vouchers, which

families can use to rent housing on the

private market.10 But there are 10 million

families eligible for housing subsidies

that do not receive them because of lack

of funding. Most cities have waiting lists

that stretch from two to five years for

housing units and rent subsidies. Without

a housing subsidy, a family has to make

$16.31 an hour ($33,924.80 annually) to

afford housing at the national fair market

rent; the hourly rate is much higher in higher-cost rental markets, such as

Washington, DC; Boston, Massachusetts; and Alameda County, California.11

In addition to housing, families experiencing homelessness need and benefit from

services. Services can help families access and maintain stable housing as well as

increase economic self-sufficiency and improve family and child well-being.

Because families who experience homelessness have different needs, there is no

cookie cutter service delivery model that works for all families. While some fam-

ilies are able to transition out of homelessness with minimal supportive services,

others require more intensive supportive services to exit the homeless assistance

system and remain stably housed. Once back in housing, links to mainstream

services—for example, mental health counseling, child development services, or

employment training—are important for building strong families that are no

longer at risk of homelessness.

7

Resources

National Alliance to End Homelessnesswww.endhomelessness.org/section/policy/focusareas/families

National Alliance to End Homelessness,“Promising Strategies to End FamilyHomelessness,” June 2006www.endhomelessness.org/content/article/detail/999

National Center on FamilyHomelessnesswww.familyhomelessness.org

National Low Income Housing Coalitionwww.nlihc.org

Expert SourcesEllen Bassuk, National Center on

Family HomelessnessSheila Crowley, National Low Income

Housing CoalitionDebra Rog, WestatNan Roman, National Alliance to End

HomelessnessMarybeth Shinn, New York University


About half of the people who experience homelessness over the course of a year

are single adults.12 Most enter and exit the homeless system fairly quickly. The

remainder live in the homeless assistance system, or in a combination of shel-

ters, hospitals, jails, and prisons or on the streets. An overwhelming majority (80

percent) of single adult shelter users

enter the homeless system only once or

twice, stay just over a month, and do not

return. Approximately 9 percent enter

nearly five times a year and stay nearly

two months each time. This group utilizes

18 percent of the system’s resources. The

remaining 10 percent enter the system

just over twice a year and spend an aver-

age of 280 days per stay—virtually living

in the system and utilizing nearly half its

resources.13

Many of these individuals are defined by

the Department of Housing and Urban

Development (HUD) as chronically home-

less.14 They often cycle between home-

lessness, hospitals, jails, and other insti-

tutional care and often have a complex

medical problem, a serious mental illness

like schizophrenia, and/or alcohol or

drug addiction. There are approximately

150,000 to 200,000 chronically home -

less individuals nationwide.15 Although8

ResourcesNational Alliance to End Homelessness

www.endhomelessness.org/section/policy/focusareas/chronic

National Alliance to End Homelessness,“Chronic Homelessness Policy Brief”www.endhomelessness.org/content/article/detail/1060

Permanent Supportive Housing Cost-Effectiveness Studywww.csh.org/html/NYNYSummary.pdf

Expert SourcesDennis Culhane, University of

PennsylvaniaNan Roman, National Alliance to End

HomelessnessCarol Wilkens, Corporation for

Supportive Housing

Homeless Adults


chronic homelessness represents a small share of the overall homeless popula-

tion, chronically homeless people use up more than 50 percent of the services.16

The most successful model for housing people who experience chronic homeless-ness is permanent supportive housing using a Housing First approach. Permanentsupportive housing combines affordable rental housing with supportive servicessuch as case management, mental health and substance abuse services, healthcare, and employment. Research shows that permanent housing is cost-effective,saving communities thousands of dollars in the cost of hospital stays, jail, andother institutional care.

9

Rural Homelessness

America’s small towns and communities are not immune to the problem of home-lessness. The number of people who experience rural homelessness is unknown,but the last national count of homeless people found that 9 percent live in ruralareas.17

Advocates and researchers often refer to people who experience rural homeless-ness as the “hidden homeless.” Many rural homeless people live in places we donot see; they often are sleeping in the woods, campgrounds, cars, abandoned farmbuildings, or other places not intended for habitation. Many more individuals andfamilies in rural areas live in substandard housing or are doubled up. These house-holds are at risk of homelessness.

The same structural factors that contribute to urban homelessness—lack of afford-able housing and inadequate income—also lead to rural homelessness.Historically, the greatest housing concern for rural Americans has been poor hous-ing quality. There have been significant improvements in rural housing quality


over the past several years; however, the fact remains that approximately 1.5 mil-lion (6.6 percent) rural homes are classified as substandard, according to the 2003American Housing Survey.18 Residents in substandard housing are often forced toseek safer, more expensive housing that they are unable to afford. As a result,poor-quality housing can lead to periods of homelessness.

Insufficient income, high rates of poverty, and unemployment also lead to ruralhomelessness. Rural homelessness is most dramatic in areas that experiencehigh economic growth, thus driving up housing costs, and in areas with highrates of unemployment because of declining industries, such as farming, timber,mining, or fishing.19 The lack of available jobs and steady incomes means thathousehold income is significantly lower in rural areas; according to the latest

report by the U.S. Census Bureau, themedian income for households living innon-metropolitan areas was $37,564,compared to $48,474 for metropolitanareas. Poverty is a persistent problem inrural America. The national poverty rateis 12.6 percent, whereas the poverty ratein rural areas is 14.5 percent,20 and 189of the 200 poorest counties are rural.21

Perhaps most staggering is the problemof child poverty. More than 19 percent ofrural children live in poverty (an increaseof over 3 percent from 2000).22

As noted earlier, other predictors of home-lessness, such as substance abuse andmental illness, contribute to rural home-

lessness. Those who experience rural homelessness report higher rates of alcoholabuse and domestic violence, but lower rates of mental illness and drug abusethan the urban homeless population.23 However, more recent research suggeststhat, when looking at substance use trends for the entire population, there is nodifference in reported substance abuse between rural and urban residents.24

10


www.endhomelessness.org/section/policy/focusareas/rural

Housing Assistance Councilwww.rural.org

Expert SourcesMartha Burt, Urban InstituteNan Roman, National Alliance to End

Homelessness


Youth homelessness is disturbingly common. Although the prevalence of youthhomelessness is difficult to measure, researchers estimate that about 5 to 7.7 per-cent of youths experience homelessness each year.25

The same factors that contribute to adult homelessness, such as poverty, lack ofaffordable housing, low education levels, unemployment, mental health, and sub-stance abuse, can lead to homelessness among youths. Beyond these factors,youth homelessness is largely a reflection of family breakdown.26 Youths becomehomeless for myriad reasons, including running away from home, being aban-doned by their parents or guardians, being emancipated, or being discharged fromsome sort of state care. Although family conflict also plays a role in adult home-lessness, the nexus is more critical for youths because they are, by virtue of theirdevelopmental state in life, still largely financially, emotionally, and, dependingon their age, legally dependent upon theirfamilies.

Youths transitioning out of foster care areat high risk of becoming homeless. Everyyear between 20,000 and 25,000 youths,ages 18 and older, age out of the fostercare system.27 Without a home, family sup-port, or other resources, homeless youthsare often locked up because they are with-out supervision. Homeless youths aresocially marginalized and often arrestedfor “status” offenses, such as runningaway or breaking curfew. Twenty-five per-cent of former foster youths nationwidereported that they had been homeless at

11

ResourcesNational Alliance to End Homelessness,

“Fundamental Issues of Preventingand Ending Youth Homelessness”www.endhomelessness.org/content/article/detail/1058

Expert SourcesNan Roman, National Alliance to End

HomelessnessPaul Toro, Wayne State University

Youth Homelessness


least one night within 2.5 to 4 years after exiting foster care.28 For youths who arereleased from juvenile corrections facilities, reentry is often difficult because theylack support systems and opportunities for work and housing.

Homelessness has serious consequences for young people and is especially danger-ous for those between the ages of 16 and 24 who do not have familial support.Living in shelters or on the streets, unaccompanied homeless youths are at ahigher risk for physical and sexual assault or abuse and physical illness, includingHIV/AIDS. It is estimated that 5,000 unaccompanied youths die each year as aresult of assault, illness, or suicide.29 Furthermore, homeless youths are at a higherrisk for anxiety disorders, depression, posttraumatic stress disorder (PTSD), andsuicide because of increased exposure to violence while living on their own.30

Homeless youths are also more likely to become involved in prostitution, to useand abuse drugs, and to engage in other dangerous and illegal behaviors.

12

Veterans

Convergent sources estimate that between 23 and 40 percent of homeless adultsare veterans, which matches the proportion of veterans in the overall U.S. popu-lation.31 The U.S. Department of Veterans Affairs (VA) estimates that as many as200,000 homeless people are veterans, and that over the course of the year, asmany as 500,000 veterans experience homelessness. The veterans are of differentwars and conflicts, including World War II, Korean War, Cold War, Vietnam War,Grenada, Panama, and Lebanon; research indicates that those serving in the late-Vietnam and post-Vietnam era are at greatest risk of homelessness. Recent mediaaccounts highlight a small but growing trend of veterans from Iraq andAfghanistan showing up in shelters; however, there has been no rigorous studydocumenting this phenomenon.


Most homeless veterans are male. The VA estimates that as few as 3 percent of

homeless veterans are female; however, this number has the potential to increase

over time as the number of women veterans increases. The National Survey of

Homeless Assistance Providers and Clients (NSHAPC), conducted in 1996, found

that almost 46 percent of homeless veterans were white males and 46 percent were

45 or older; more than half (56 percent) had

completed high school or a GED program.

An overwhelming majority (76 percent) of

respondents in the survey reported experi-

encing alcohol, drug, or mental health

problems. Homeless veterans re ported

needing help finding a job (45 percent) and

finding housing (37 percent).32

The causes of homelessness among veter-

ans are difficult to disentangle. Homeless

veterans suffer from high rates of PTSD

and mental illness. While these rates are

high, they are similar to the rates of men-

tal health problems in other homeless

adults. Robert Rosenheck (1996), a re -

searcher at Yale Medical School, writes

that “…homelessness among veterans is

not clearly related to military experience.

Rather, it is the result of the same interre-

lated economic and personal factors that

cause homelessness in the civilian popula-

tion.”33 In other words, the same things

that predict homelessness among the

general population—poverty, health and mental health issues, lack of affordable

housing—also predict homelessness among veterans. However, veterans face

additional challenges when trying to overcome these obstacles: prolonged sepa-

ration from traditional supports such as family and close friends; highly stress-

ful training and occupational demands that can affect their personality, self-

esteem and ability to communicate; and non-transferability of skills to civilian

jobs. Studies show that up to one-third of combat veterans are likely to experi-

ence some clinical degree of depression, post-traumatic stress disorder, or other

emotional and psychological difficulties directly related to their military

expense.34

13


www.endhomelessness.org/section/policy/focusareas/veterans

National Alliance to End Homelessness,“Fact Checker: Homelessness andVeterans”www.endhomelessness.org/content/article/detail/1401

National Coalition for Homeless Veteranswww.nchv.org

Expert SourcesCheryl Beversdorf, National Coalition

for Homeless VeteransNan Roman, National Alliance to End

HomelessnessRobert Rosenheck, Yale MedicalSchool


Each year, more than 650,000 people are released from state prisons in the United

States, and an estimated 12 million are released from jails.35,36 Many former pris-

oners are at risk of homelessness, and if these individuals do become homeless,

their likelihood of returning to prison increases because they are more likely to

violate their parole, either for technical violations or by committing a crime.

Conversely, more than 10 percent of those coming in and out of prisons and jail

are homeless in the months before their incarceration. For those with mental

illness, the rates are even higher—about

20 percent.37 Forty-nine percent of home-

less adults have reportedly spent five or

more days in a city or county jail over their

lifetimes, and 18 percent have been incar-

cerated in a state or federal prison,

according to a 1996 HUD study.38

Shelter use, both before incarceration and

after release, is associated with an

increased risk of return to prison. In a

study of 50,000 individuals who were

released from New York State prisons and

returned to New York City between 1995

and 1998, the risk of returning to prison

increased 23 percent with prerelease shel-

ter stay, and 17 percent with post-release

shelter stay.39 Prison and jail are among

the most expensive settings to serve peo-

ple who are homeless: one nine-city study

calculated median daily costs for prison14


www.endhomelessness.org/section/policy/focusareas/reentry

National Alliance to End Homelessness,“Prison Reentry and Homelessness”www.endhomelessness.org/content/article/detail/1082

Re-Entry Policy Councilwww.reentrypolicy.org

Urban Institutewww.urban.org

Expert SourcesCaterina Gouvis Roman, Urban InstituteNan Roman, National Alliance to End

Homelessness

Prisoner Reentry


Domestic violence is the immediate cause of homelessness for many women. In a

national survey of homeless people, domestic violence was the second most fre-

quently stated cause of homelessness for families, with 13 percent of homeless

families saying that they had left their last

place of residence because of abuse or vio-

lence in the household.42 Other local sur-

veys have found even higher percentages

of families becoming homeless as a direct

result of domestic violence.

The consequences of domestic violence

can affect a woman’s likelihood of becom-

ing homeless. Domestic violence victims

are often isolated from support networks

and financial resources by their abusers.

As a result, they may lack steady income,

employment history, credit history, and

landlord references. Women survivors of

physical assault also often suffer from anx-

iety, panic disorder, major depression,

and substance abuse.43

and jail at $59.43 and $70.00, respectively, compared with $30.48 for supportive

housing.40 Supportive housing has been documented to drastically reduce criminal

justice involvement, reducing jail incarceration rates up to 30 percent and prison

incarceration rates up to 57 percent.41

15


www.endhomelessness.org/section/policy/focusareas/violence

National Network to End DomesticViolencewww.nnedv.org

National Center on Family Homelessnesswww.familyhomelessness.org

Expert SourcesEllen Bassuk, National Center on

Family HomelessnessNan Roman, National Alliance to End

Homelessness

Domestic Violence


Many homeless women have been victims of domestic violence at some point intheir past, even if they do not identify it as the immediate cause of their home-lessness. One study in Massachusetts found that 92 percent of homeless womenhad experienced severe physical or sexual assault at some point in their life, 63percent had been victims of violence by an intimate partner, and 32 percent hadbeen assaulted by their current or most recent partner.44

Domestic violence victims have both short- and long-term housing needs that mustbe met so that they do not need to choose between staying with their abuser andsleeping on the street. Immediately, domestic violence victims need a safe placeto stay. Emergency shelters are an important temporary haven for domestic vio-lence victims. Ultimately, domestic violence victims need safe, stable, and afford-able housing. An adequate supply of affordable housing is critical to ensuring thatsurvivors of domestic violence can afford to leave the shelter system as quickly aspossible without returning to their abuser.

16

Mental and Physical Healthand Substance Abuse

Homeless people suffer from high rates of mental and physical health problemsexacerbated by living on the streets and in shelters. The lack of residential stabil-ity makes health care delivery more complicated. Health conditions that requireongoing treatment—such as diabetes, cardiovascular diseases, tuberculosis,HIV/AIDS, and mental illness—are difficult to treat when people are living in shel-ter or on the streets.45 Homeless people often lack access to preventative care,waiting until a trip to the emergency room is a matter of life or death. These emer-gency room visits are costly. Additionally, when homeless people become ill, theyoften do not receive timely treatment.


In addition to chronic health problems, approximately half of homeless people suf-fer from mental health issues. At a given point in time, 45 percent of homeless peo-ple report indicators of mental health problems during the past year, and 57 percentreport having had a mental health problem during their lifetime.46 About 25 per-cent of the homelessness population hasserious mental illness, including such diag-noses as chronic depression, bipolar disor-der, schizophrenia, schizoaffective disor-ders, and severe personality disorders.47

Many homeless people have problemswith drug and alcohol use. In a 1996 sur-vey, 46 percent of the homeless respon-dents had an alcohol use problem duringthe past year, and 62 percent had an alco-hol use problem at some point in theirlifetime. Thirty-eight percent had a prob-lem with drug use during the past year,and 58 percent had a drug use problemduring their lifetime.48

17


www.endhomelessness.org/section/policy/focusareas/health

National Healthcare for the HomelessCouncilwww.nhchc.org

National Alliance on Mental Illnesswww.nami.org

Expert SourcesArturo Bendixen, AIDS Foundation

of ChicagoNancy Bernstine, National AIDS

Housing CoalitionJim O’Connell, Boston Healthcare for

the HomelessNan Roman, National Alliance to End

HomelessnessRobert Rosenheck, Yale Medical School


Frequently Asked QuestionsHow Much Does the Federal Government Spend on Homelessness?

Answering the question about how much the federal government spends on home-lessness should be as simple as summing the total expenditures for homeless assis-tance programs. Homeless programs, however, do not fit neatly into one federalagency; instead they are spread across several, including the Department ofHousing and Urban Development (HUD), the Department of Health and HumanServices (HHS), The Social Security Administration (SSA), the Department ofHomeland Security (DHS), and the Department of Veterans Affairs (VA). These fed-eral agencies administer programs that are dedicated to serving homeless people—meaning that the goals and eligibility requirements target homeless people—andmainstream programs that serve homeless people as well as other low-income peo-ple, for example, Medicaid, Temporary Assistance to Needy Families (TANF), ormainstream housing and community development programs (Section 8, publichousing, Community Development Block Grant, HOME). The figures below focus onhow much is spent on dedicated homeless assistance programs and examine trendsin HUD funding for low-income housing programs.

In 2006, the federal government spent $1.928 billion dollars on dedicated home-less programs. The Homelessness Assistance Grants is the primary source of fund-ing for homeless people. McKinney-Vento funds Emergency Shelter Grants,Supportive Housing programs, and Shelter Plus Care. Since 2001, McKinney-VentoHomeless Assistance funding has been increasing slightly, with a dip in 2005.Other major programs for homelessness programs include Health Care for theHomeless, funded by the HHS, and the Emergency Food and Shelter Program,funded by the DHS.

Federal spending on homelessness is on an upward trajectory. From 2001 to 2006,dedicated federal funding for homelessness increased 9 percent, from $1.762 to$1.928 billion. If approved, the President’s FY 2007 budget request of $2.140 bil-lion would continue this trend, increasing federal homeless spending by 10 per-cent from 2006 to 2007.

While federal funding for homeless assistance programs has increased slightly,funding for housing assistance programs for low-income households—a criticalcomponent of ending homelessness—has not increased significantly since 2003. In2001, federal funding for housing assistance totaled $29 billion; funding increasedto $31.7 billion in 2003 and then decreased slightly in 2005 ($31 billion) and 2006($31.4 billion).

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What Is Housing First?

“Housing First” is an approach that guides a set of interventions designed to helphomeless families or individuals transition more rapidly out of the shelter system;it includes crisis intervention, re-housing as quickly as possible, follow-up casemanagement, and housing support services to prevent the reoccurrence of home-lessness. The approach is based on two basic principles: (1) the best way to endhomelessness for the vast majority of people is to help them move into permanenthousing as quickly as possible; and (2) once in housing, formerly homeless peoplemay require some level of services to help them stabilize, link them to long-termsupports, and prevent reoccurrence. What differentiates a Housing First approachfrom traditional emergency housing or transitional models is that there is animmediate and primary focus on helping those in need quickly access and thensustain housing—put simply, housing comes first, then services. While HousingFirst interventions may sound intuitive (homeless people need housing), the addi-tion of Housing First services in a community can radically transform how peopleexperience homelessness. Further, once a family or an individual is in housing,that family or individual is more responsive to interventions and support that leadto better outcomes.

What Is Permanent Supportive Housing?

Permanent supportive housing (PSH) is affordable housing linked to support serv-ices. A PSH unit is intended for a person or family whose head of household ishomeless or at risk of homelessness and experiencing mental illness, other chronichealth conditions including substance use issues, and/or multiple barriers toemployment and housing stability. Typically, the tenant pays no more than 30 to50 percent of household income toward rent and has a lease or similar form ofoccupancy agreement with no limits on length of tenancy, as long as the house-hold abides by the conditions of the lease. Additionally, the tenant has access toa flexible array of comprehensive services including medical and wellness, mentalhealth, substance use management and recovery, vocational and employment,money management, coordinated support (case management), life skills, house-hold establishment, and tenant advocacy.49

Nonprofits develop PSH using different funding streams for operating costs, serv-ices costs, and capital. Section 8 vouchers and Shelter Plus Care are often usedfor operating costs. Services are more difficult to fund; generally, organizationsmust piece together different sources of services financing in order to run theirprograms.

There are many benefits of permanent supportive housing. PSH reduces the use ofother public systems by its consumers and prevents people from becoming orremaining homeless for extended periods. In one study, placement in PSH led to

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decreases of more than 50 percent in emergency room visits and hospital inpatientdays, and an increase of 50 percent in earned income.50

PSH works in part because it addresses the top priorities of many of its clients.Mothers who are part of the Family Permanent Supportive Housing Initiative listedtheir two most desired housing characteristics as “having a sense of privacy” and“having a key to their own place,” both of which were achieved in that program.51

For PSH consumers who have mental illness, substance abuse problems, or otherdisabilities, the structure of integrated yet separate housing and services allowsfor a sense of normality; they live independently in an apartment for which theyhave signed a lease, just like any tenant renting an apartment in the private mar-ket. Supportive services that are linked to the unit help them remain housed andenhance their quality of life and well-being.

PSH is a proven solution to ending homelessness for chronically homeless people.Currently, there are somewhere between 20,000 and 30,000 units of PSH provid-ing services.52

What Is the Ten Year Plan? How Many Local Ten Year Plans Exist?

In 2000, the Alliance announced A Plan, Not a Dream: How to End Homelessness inTen Years. This plan offers a framework on how communities can end homeless-ness by planning for outcomes, closing the front door to homelessness, openingthe back door out of homelessness, and building infrastructure. The announce-ment of this plan created a snowball effect across the country. The BushAdministration and Congress have adopted as goals significant parts of the TenYear Plan, and opinion leaders have begun to echo the language and key conceptsof the plan. Moreover, cities and states across the nation have taken up the chal-lenge to end homelessness in their communities. Today more than 220 communitiesare planning to end homelessness; over 92 have completed plans. Across the country,the movement to end homelessness is growing.

Endnotes1 Burt, M. R., and Aron, L. Y. 2000. “America’s Homeless II: Populations and Services.” Washington,DC: The Urban Institute. 2 National Alliance to End Homelessness. 2007. Homelessness Counts. Washington, DC: Author.3 Culhane, D. 2004. Family Homelessness: Where to From Here? October 14, 2004 to the NationalAlliance to End Homelessness Conference on Ending Family Homelessness. PowerPoint availableonline at http://www.endhomelessness.org/back/FamilyHomelessness.pdf4 Burt, M. R. 2001. “What Will it Take to End Homelessness?” Washington, DC: Urban Institute.5 Ibid.

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6 Shin, M., Weitzman, B. C., Stojanovic, D. Knickman, J. R., Jimenez, L., Duchon, L., James, S., andKrantz, D. H. 1998. “Predictors of homelessness among families in New York City: From shelterrequest to housing stability.” American Journal of Public Health, 88 (11): 1561–1657.7 Ibid.8 Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., and Perloff, J. N.1997. “Homelessness in female-headed families: Childhood and adult risk and protective factors.”American Journal of Public Health, 87 (2): 241–248.9 Shin, M., Weitzman, B. C., Stojanovic, D. Knickman, J. R., Jimenez, L., Duchon, L., James, S., andKrantz, D. H. 1998. “Predictors of homelessness among families in New York City: From shelterrequest to housing stability.” American Journal of Public Health, 88 (11): 1561–1657.10 Ibid.11 Pelletiere, D., Wardrip, K., and Crowley, S. 2006. “Out of Reach: 2006”. Washington, DC: NationalLow Income Housing Coalition.12 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. Homelessness: Programsand the People They Serve, Findings of the National Survey of Homeless Assistance Providers and ClientsTechnical Report. Urban Institute. Washington, DC: Interagency Council on the Homeless.13 Kuhn, R. & Culhane, D. P. 1998. Applying cluster analysis to test of a typology of homelessness: Resultsfrom the analysis if administrative data. American Journal of Community Psychology, 17 (1), 23–43.14 According to HUD’s definition, a person who is ‘‘chronically homeless’’ is an unaccompanied home-less individual with a disabling condition who has either been continuously homeless for a year ormore, or has had at least four (4) episodes of homelessness in the past three (3) years. In order to beconsidered chronically homeless, a person must have been sleeping in a place not meant for humanhabitation (e.g., living on the streets) and/or in an emergency homeless shelter. A disabling condition isdefined as a diagnosable substance use disorder, serious mental illness, developmental disability, orchronic physical illness or disability including the co-occurrence of two or more of these conditions. Adisabling condition limits an individual’s ability to work or perform one or more activities of daily living.15 National Alliance to End Homelessness tabulations of Continuum of Care 2005 point in time estimates.16 Kuhn, R. & Culhane, D. P. 1998. Applying cluster analysis to test of a typology of homelessness: Resultsfrom the analysis if administrative data. American Journal of Community Psychology, 17 (1), 23–43.17 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. Homelessness: Programsand the People They Serve, Findings of the National Survey of Homeless Assistance Providers and ClientsTechnical Report. Urban Institute. Washington, DC: Interagency Council on the Homeless.18 U.S. Census Bureau and U.S. Department of Housing and Urban Development (2004). 19 Aron, L. Y., and Fitchen, J. M. 1996. “Rural Homelessness: A Synopsis.” Homelessness in America(Jim Baumohl, ed.). Phoenix, AZ: Oryx Press.20 U.S. Census Bureau and United States Department of Housing and Urban Development. 2004.American Housing Survey for the United States: 2003. Washington, DC. Available at http://www.census.gov/prod/2004pubs/H150-03.pdf. 21 Housing Assistance Council. 2002. Taking Stock: Rural People, Poverty, and Housing at the Turn ofthe 21st Century. Washington, DC. Available at http://www.ruralhome.org/pubs/hsganalysis/ts2000/1TSfrontice.pdf. 22 Carsey Institute. 2006. Child Poverty in Rural America: New Data Shows Increases in 41 States.Durham, NH: University of New Hampshire.23 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. Homelessness: Programsand the People They Serve, Findings of the National Survey of Homeless Assistance Providers and ClientsTechnical Report. Urban Institute. Washington, DC: Interagency Council on the Homeless.24 Van Gundy, K. 2006. Substance Abuse in Rural and Small Town America. Carsey Institute. Durham,NH: University of New Hampshire.25 Robertson, M. J., and Toro, P. A. 1998. Homeless Youth: Research, Invention, Policy. NationalSymposium on Homelessness Research. Washington, DC: U.S. Department of Health and Human Services26 Center for Law and Social Policy. 2003. Leave No Youth Behind: Opportunities to Reach DisconnectedYouth, p. 57.27 Allen, M., and Nixon, R. 2000. “The Foster Care Independence Act and the John H. Chafee FosterCare Independence Program: New catalyst for reform for young people aging out of foster care.”Journal of Poverty and Policy, July–August.28 Anne E. Casey Foundation. 2004. “2004 Kids Count Data Book” Washington, DC: Annie E. CaseyFoundation.29 National Law Center on Homelessness and Poverty. 2004. “Legal Tools to End Homelessness”Washington, DC: National Law Center on Homelessness and Poverty.

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30 Healthcare for the Homeless Clinician’s Network. “Protecting the Mental Health of HomelessChildren and Youth.” Healing Hands, 4(1), Feb. 2000.31 Rosenheck, R. A., Lea, C., Frisman, L. K., Lam, J., and Chung, A. 1996. “Homeless Veterans.”Homelessness in America (Jim Baumohl, ed.). Phoenix, AZ: Oryx Press.32 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. “Homelessness:Programs and the People They Serve. Findings of the National Survey of Homeless AssistanceProviders and Clients.” Washington, DC: Interagency Council on the Homeless.33 Rosenheck, R. A., Lea, C., Frisman, L. K., Lam, J., and Chung, A. 1996. “Homeless Veterans.”Homelessness in America (Jim Baumohl, ed.). Phoenix, AZ: Oryx Press.34 U.S. Department of Veterans Affairs. 2004. “The Iraq War Clinician Guide, 2nd Edition.”Washington, DC:. U.S. Department of Veterans Affairs35 The number of people released from state prisons each year has been steadily increasing—fromslightly more than 600,000 in 2000 to more than 670,000 in 2004. See Paige M. Harrison and Allen J.Beck, “Prison and Jail Inmates at Midyear 2005,” U.S. Department of Justice, Bureau of JusticeStatistics (Washington, DC, 2006), NCJ 213133. 36 The jail numbers (2004) were provided by Allen J. Beck, “The Importance of Successful Reentry toJail Population Growth” (presentation at The Jail Reentry Roundtable of the Urban Institute,Washington, DC, June 27, 2006).37 Metraux, Stephen and Dennis Culhane. 2004. “Homeless Shelter Use and Reincarceration FollowingPrison Release.” Criminology and Public Policy 3(2): 139–160.38 Burt, M. R., et al., Homelessness: Programs and the People They Serve: Findings From the NationalSurvey of Homeless Assistance Providers and Clients, U.S. Department of Housing and UrbanDevelopment (Washington, DC: 1999), cited in Stephen Métraux and Dennis P. Culhane. 2004.“Homeless Shelter Use and Reincarceration Following Prison Release: Assessing the Risk,”Criminology & Public Policy 3(2):201–222.39 Metraux, Stephen and Dennis Culhane. 2004. “Homeless Shelter Use and Reincarceration FollowingPrison Release.” Criminology and Public Policy 3(2): 139–160.40 The Lewin Group. 2004. “Costs of Serving Homeless Individuals in Nine Cities.” Chart Book Report.New York: Corporation for Supportive Housing.41 Culhane, D. P., et al. 2002. “Public Service Reductions Associated with Placement of HomelessPersons with Severe Mental Illness in Supportive Housing,” in Housing Policy Debate, Vol. 13, Issue 1.Fannie Mae Foundation. 42 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. “Homelessness:Programs and the People They Serve. Findings of the National Survey of Homeless AssistanceProviders and Clients.” Washington, DC: Interagency Council on the Homeless.43 Bassuk, E.L, Melnick, S. and Brone, A. 1998. “Responding to the needs of low Income and homelesswomen who are survivors of family violence.” Journal of American Medical Association, 53(2): 57–64. 44 Ibid.45 Health Care for the Homeless Council. 2006. “Health Care and Homelessness.” Washington, DC:Health Care for the Homeless Council.46 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. “Homelessness:Programs and the People They Serve. Findings of the National Survey of Homeless AssistanceProviders and Clients.” Washington, DC: Interagency Council on the Homeless.47 Rosenheck, R., Barruk, E., and Salomon, A. 1999. “Special Populations of Homeless Americans.” InFosburg, L., and Dennis, D. (eds), Practical Lessons. Washington, DC: HHS & HUD. Koegel, P., Burnam,M.A., and Baumohl, J. 1996. “The Causes of Homelessness.” In Baumohl, J. (ed), Homelessness inAmerica. Phoenix, AZ: Oryx Press, pp. 24–33. Cordray, D., and Lehman, A. 1993. “Prevalence of alco-hol, drug, and mental disorders among the homeless.” Contemporary Drug Problems 20: 355–384.48 Burt, M. R., Aron, L. Y., Douglas, T., Valente, J., Lee, E., and Iwen, B. 1999. “Homelessness:Programs and the People They Serve. Findings of the National Survey of Homeless AssistanceProviders and Clients.” Washington, DC: Interagency Council on the Homeless.49 Corporation for Supportive Housing. March 2006. “What Is Supportive Housing?” Oakland, CA:Corporation for Supportive Housing.50 Culhane, D. P., Metraux, S & Hadley, T.R. 2002. “Public service reductions associated with theplacement of homeless people with severe mental illness in supportive housing.” Housing PolicyDebate, 13 (1), 107–163.51 Burt, M. R., and Nolan, C. 2004. “The Family Permanent Supportive Housing Initiative: PreliminaryFindings Report.” Washington, DC: Urban Institute.52 Corporation for Supportive Housing tabulations of permanent supportive housing units 2006.

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