Addressing Chronic Homelessness

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Addressing Chronic Homelessness

• Issues and Promising Practices

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Chronic Homelessness
HHS, HUD, and VA use the following working
definition of chronic homelessness in their
collaborations An unaccompanied individual with
a disabling condition who has either been
continuously homeless for a year or has had at
least 4 episodes of homelessness in the past 3
years
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How Many?

• 80 of the estimated 2 to 3 million people who
  experience homelessness each year exit within 3
  to 4 weeks
• 10 are homeless more episodically
• 10 experience chronic homelessness

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Why Address Chronic Homelessness?

• They have greater difficulty exiting homelessness
  on their own
• Although small in numbers, they use half of all
  emergency assistance for people who are homeless
• Placing them in supportive housing saves money

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Who Are They?

• At least 75 male, 40 of whom are veterans
• At least 40 African American
• Tend to be older

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What Issues Do They Face?

• 40 have substance use disorders
• 25 have physical disabilities or disabling
  health conditions
• 20 have serious mental illnesses
• 66 have more than one of these conditions

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What Prevents Them from Exiting Homelessness?

• Persistent poverty
• Lack of affordable housing
• Disabling health and behavioral health conditions
• Service system barriers

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Poverty

• Most rely on public entitlement programs (e.g.,
  SSI, SSDI, VA) for income
• Even with income support, they remain below the
  Federal poverty level
• Many do not receive benefits they are entitled to
• People with a primary diagnosis of a substance
  use disorder are not eligible for SSI

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Housing

• Lack of affordable housing options for very
  low-income people
• People with disabilities on SSI must pay 105 of
  income to rent a modest one-bedroom unit at Fair
  Market Rent
• Average wait for Section 8 rental assistance is
  more than 2 years

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Disability

• Have multiple needs that cant be addressed by
  one system
• Burden of accessing and coordinating services and
  treatment falls on the individual
• Stigma and discrimination are major barriers to
  accessing housing and services

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Service System Barriers

• Service systems and funding are fragmented
• Administrative procedures are restrictive and
  burdensome
• Resources (housing and services) are insufficient
• Treatment and services programs are sometimes
  ineffective

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What Works? -Core Services

• Outreach and engagement
• A range of housing options with flexible support
  services
• Clinical case management
• Integrated health and behavioral health care
• Substance abuse treatment
• Primary health care
• Mental health treatment
• Income support and entitlement assistance

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What Works? -Supportive Services

• Rehabilitation, training, and employment services
• Life skills training
• Legal assistance
• Transportation

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What Works? -Prevention Services

• Comprehensive discharge planning from shelters,
  hospitals, and jails
• Time-limited, intensive supports during periods
  of transition
• Crisis intervention

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The Challenge

• To ensure that people who experience chronic
  homelessness have full access to both targeted
  and mainstream programs

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Mainstream Federal Programs

• Income/Employment
• Department of Labor programs
• SSI/SSDI
• TANF
• Services
• Medicaid
• Mental Health Block Grant
• Substance Abuse Block Grant
• Community Health Centers
• Community Services Block Grant
• Social Services Block Grant

• Housing
• Section 8
• HOME
• HOPWA
• Community Development Block Grant
• Section 811
• Veterans Programs

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Action Plans to Address Chronic Homelessness

• State Activities and Accomplishments

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Common Priority Areas/Themes

• Increasing coordination and collaboration
• Data/information gathering and integration of
  data systems
• Increasing access to mainstream system resources
• Increasing supply of/access to affordable housing
• Increasing prevention and discharge planning
• Implementing best practices
• Increasing public education and awareness

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Key Strategies for Increasing Coordination and
Collaboration

• Implement/reactivate ICH
• Develop and support infrastructure to ensure
  ongoing activity and progress on plan
  implementation
• Continued involvement of Policy Academy Team
  members and/or key leadership
• Enhanced partnerships through expanded
  membership/ inclusion of new stakeholders
• Integration of planning activities (e.g.,
  family/chronic, State/local/Continuum of Care
  plans)

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Key Data/Information Strategies

• Studies to estimate numbers/need (e.g.,
  point-in-time surveys)
• Cost studies
• Housing status as uniform data item within all
  mainstream data collection systems
• Development/implementation of HMIS systems and
  integration with other (mainstream) data systems
• Development of performance/outcome measures,
  using HMIS and mainstream data systems to monitor
  progress

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Strategies for Increasing Access to Mainstream
Resources

• Universal application for TANF, Food Stamps,
  Medicaid
• Streamlining eligibility/training to improve
  access to SSI/SSDI
• Collaboration/cross-training with Veterans,
  Employment, Mental Health, Substance Abuse
  programs on homelessness
• Use of TANF and Medicaid funding for services
  (e.g., housing assistance, mental health/ACT
  services)
• Using mainstream housing resources (e.g., HOME,
  CDBG)

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Strategies to Increase Supply of/Access to
Affordable Housing

• Public/private partnerships and Housing Trust
  Funds to develop affordable housing
• Use of CDBG, HOME, State funds to create new
  housing and/or subsidy programs
• Increasing income through employment training and
  access to income supports
• Modification of eligibility requirements for
  housing
• Landlord outreach, advocacy, and support
• Provider training on housing chronically homeless
  people

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Prevention Strategies

• Identification of risk factors and targeting
  prevention efforts to specific subgroups (e.g.,
  substance abusers)
• Development, implementation and
  monitoring/enforcement of discharge policies that
  prevent homelessness (zero- tolerance policies)
• Pilot programs for ex-offenders (in-reach,
  housing assistance, post-release support services
  )
• Creating/setting aside housing for people exiting
  mental health institutions, other at-risk
  populations

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Implementation of Best Practices

• Implementation of Housing First approach
• ACT as standard case management model
• Increased outreach with linkage to housing and
  services
• Pilot projects testing new approaches to housing
  and service integration

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Increasing Education and Awareness

• Statewide conferences/summits on housing and
  homelessness
• Public awareness campaigns (TV, print, radio)
• Educating policymakers