Ending Homelessness Today — Chronic Homelessness
Alliance President Keynote Remarks, 2013 National Family and Youth Conference
May 10, 2013
Back in February, about 900 advocates, practitioners, and officials convened in Seattle for two days of sharing innovative practices and new research on family and youth homelessness at the Alliance’s 2013 National Conference on Ending Family and Youth Homelessness. These are the keynote remarks delivered by the Alliance's President and CEO Nan Roman at that conference.
Read More »
Mental Health and Military Appreciation
May 09, 2013
In our media-driven, socially-conscious era, every month has its many associations, and May is no exception. Did you know that May is National Salad Month? Neither did I. It’s also National Mental Health Awareness month and Military Appreciation Month. It’s fitting that these two issues share a month because, due to over ten years of continuous conflict, they are inextricably linked.
With a small, all-volunteer military pressed into duty for over a decade, many service members have faced multiple deployments and experienced sexual trauma, horrifying urban combat, traumatic head wounds, and they have suffered from lack of employment opportunities when they return home. All of these factors can contribute to mental health issues.
As many as 40 percent of all veterans will experience some form of mental health or trauma related symptoms as a result of their service. These are complex and often long lasting conditions that veterans will live with for many years. The Department of Defense (DoD) and the Department of Veterans Affairs (VA) have both struggled to come to grips with this growing problem.
Read More »
Homelessness and Mental Health: Moving Past Stereotypes
May 06, 2013
Many people automatically associate homelessness with mental illness, based on stereotypes of men and women on city streets, disheveled and talking to themselves. In fact, certain groups of people experiencing homelessness do live with severe mental health conditions, though this is not true of all homeless people. With May being Mental Health Awareness Month, this is a good time to take a look at the connection between homelessness and mental illness.
Of the 633,800 people who were homeless on any given night in 2012, about 99,900 people (or 18 percent) could be described as severely mentally ill. Many are chronically homeless, meaning they have been without homes for a long time or have experienced multiple episodes of homelessness. Their mental conditions make it impossible for them to remain stably housed for long without intensive help. The consensus in the homeless assistance field is that best way to help them is by providing permanent supportive housing.
That’s not the entire story, however.
Read More »
How Medicaid Can Help Homeless and At-Risk Individuals
April 29, 2013
At least three vulnerable groups could benefit from the Affordable Care Act (ACA) in ways that could reduce homelessness and risks of homelessness: chronically homeless individuals; young people aging out of foster care; and ex-offenders, also known as homecomers.
Medicaid expansion, which is optional for states, could potentially cover all uninsured men with incomes under $15,000 – meaning most chronically homeless people and homecomers would have better access to medical and behavioral health care. Under the ACA states also must extend coverage to former foster youth until age 26, which will give these young people additional time to receive ongoing treatments and services. And under the ACA signing up for Medicaid will be easier across the country, as states must remove barriers to enrollment.
The ACA will not end homelessness! Housing is the primary intervention to solve homelessness. However, vulnerable people also need supports and services to be stable in housing. Medicaid can help individuals, and covering them will help strained communities by adding resources for services that accompany housing assistance. The proof will be in implementation, starting next year.
Read More »
The State of Homelessness in America 2013: Chapter 1
April 12, 2013
This has been a busy week at the Alliance. The Homelessness Research Institute released The State of Homelessness in America 2013. This is the third installment in a series of reports that examines trends in homelessness and the economic and housing context in which those trends occur.
Today we are going to take a quick look at Chapter 1, which examines national and state level trends in homelessness. The data presented in Chapter 1 comes from Point-In-Time estimates for January 2011 and January 2012 reported to the Department of Housing and Urban Development by communities across the U.S.
Read More »
How Would the President Fund Homeless Assistance in 2014?
April 11, 2013
The President’s budget proposal, released Wednesday, provides a detailed look at this Administration’s spending priorities for the next year and beyond. Right now you can find all kinds of commentary on the proposed budget, in terms of both policy and politics, about the big picture and larger items like tax and spending policies aimed at reducing the long-term federal deficit, as well as concessions by the President to Republicans in the form of proposals to reduce spending on middle-class benefit programs.
Today, however, I want to go over a few specific items, much smaller in scale, that would have an impact on homelessness.
One important piece of background information that’s important to keep in mind: This budget proposal is based on certain assumptions about how much money overall will be available for HUD programs. While those assumptions are certainly reasonable, not all members of Congress agree on them. The President’s budget is always “just a proposal.” This year there is more uncertainty than usual, but there is a greater need for Congress to enact it.
Read More »
National Homeless Persons’ Memorial Day
December 21, 2012
The date December 21 has meanings both ancient and new. Communities in every era have paused in awareness of waning daylight and the promise of the sun’s return; in our era, some will pause to look for assurance that the world keeps turning. It is appropriate that National Homeless Persons’ Memorial Day is December 21.
For people living on the street, the darkest day of the calendar is especially dark; for a person to die on the street is an ending that should be unthinkable. Homeless advocates, today, will pause to honor the neighbors and fellow citizens who passed away in 2012 without a home.
Read More »
A Look at the New Homelessness Numbers
December 18, 2012
On Monday, December 10, The Department of Housing and Urban Development (HUD) released national numbers from the January 2012 Point-In-Time (PIT) Counts, which give an estimate of the number of people sleeping in shelters and other housing for homeless people and also in places not meant for human habitation (aka “the streets”) at a single point in time. In this case, that point in time was mid-January, 2012.
Since a lot of people around the country are entering the final month of preparation for the 2013 PIT count, I want to start by saying that having these numbers every year has turned out to be extremely important. The enumeration is not perfect. But PIT Counts have become more rigorous over the years, and we believe they provide a reliable and worthwhile estimate.
Read More »
What I Learned from My Son’s Chronic Homelessness
November 20, 2012
Recently, I argued this point in an essay for Health Affairs that later appeared in the Washington Post. I wrote that the mistakes of an earlier generation of policy makers – a generation of which I was a part – caused so much of the problem.
Many years ago, we emptied our state psychiatric institutions for good reasons. They were often monuments to neglect or abuse. But when we emptied them, we failed to put in place the community-based service delivery system we needed.
Read More »
Ending Long-Term Homelessness
November 02, 2012
Alliance and CEO Nan Roman delivered the following remarks at the Common Ground Alliance/Council of Homeless Persons Pre-conference Convening on in Melbourne, Australia on Wednesday, September 5, 2012. (For our American readers, in Australia permanent supportive housing is referred to as "common ground housing.")
Ending Long Term Homelessness: Taking Permanent Supportive Housing to Scale
Thank you to the Common Ground Alliance and Felicity Reynolds and the Council of Homeless Persons and Jenny Smith for holding this forum and for inviting me to join you today. When I first came to Australia in 2007, permanent supportive housing and Common Ground housing were quite a new idea, at least by those names. Certainly there were people like Bryan Lippman at Wintringham here in Melbourne who were already doing it – combining housing and services. But it wasn’t the norm; it was not a well-established intervention. Now, as heard this morning, there are quite a few models. That is good, as a variety of models are needed.
But the next step, as the title of this session indicates, is going to scale – moving from the occasional permanent supportive housing program to an adequate supply of permanent supportive housing to meet the need and end homelessness among people with chronic disabilities.
Read More »
When Homelessness Causes PTSD
October 17, 2012
Today’s post was written by Edward J. SanFilippo, Economic Development Policy Fellow for the Alliance.
Mention post-traumatic stress disorder (PTSD) as it relates to homelessness, and most people will probably think of military veterans, but other homeless populations struggle with PTSD. Indeed, the experience of homelessness itself is a trauma that can lead to PTSD.
PTSD is an anxiety disorder that can occur after an individual has experienced a traumatic event, particularly one that involves the threat of injury or death. It is still unclear why a particular trauma may lead to PTSD for some individuals but not for others, or why some individuals are traumatized by a particular event when others are not.
We do know that:
PTSD changes the body’s response to stress;
An individual with a history of trauma may be more susceptible to experiencing PTSD from a future traumatic event; and
Symptoms of PTSD may not appear for weeks or even months after the triggering traumatic event.
There are a number of ways in which the traumatic experience of homelessness can lead to PTSD:
The actual event of becoming homeless can lead to trauma through the loss of stable shelter, family connections, and accustomed social roles and routines;
The ongoing condition of homelessness creates stressors that include the uncertainty of where to find food and safe shelter and the potential for experiencing violence and victimization, which can erode a person’s... Read More »
Moving Forward, One Word at a Time
October 02, 2012
Today’s guest blog post was written by Kristin Pazulski, Development Director and Managing Editor for the Denver VOICE. It includes an excerpt from the 2012 issue of the Denver VOICE, written by Raelene Johnson.
Raelene Johnson spent years living on the streets of Boulder. The shady space under a bridge was her home. She scraped by on the money earned the typical way on the street, her drug habit keeping her in a cycle of poverty and homelessness.
In 2008 Johnson discovered the Denver VOICE, a street paper in Colorado. As soon she walked through the vendor office door, she was given the opportunity to work. She received one hour of training and a badge with 10 free papers in exchange for the promise to conduct herself professionally while selling the VOICE.
Grabbing her first paper and ducking into the lanyard that held a tag with her face, name and vendor number, Johnson had no idea she was embarking on a journey very different from the one she’d been on.
There are 122 street papers around the world, more than 30 in North America. These papers are connected through two large networks—the International Network of Street Papers and the North American Street Newspaper Association.
Some are volunteer-based, while others have large staffs and monthly circulations exceeding 100,000. A wire service similar to the Associated Press allows street papers around the world to share their stories. Thanks to this service,... Read More »
Join the Alliance in Tulsa, Okla.
August 23, 2012
The Alliance is proud to be a partner in From Housing to Recovery, a conference running from Sept. 19 through 21 in Tulsa, Okla.
In many ways, this three-day event exemplifies the kind of collaboration and focus we need if we are to address the problem of chronic homelessness and meet the goal of ending it by 2015, as set in the Federal Strategic Plan to Prevent and End Homelessness.
From Housing to Recovery, though initiated by private and non-profit champions in the Tulsa mental health community, is more than a local affair. It’s a national meeting as well, co-sponsored by Mental Health America. The event is about recovery, and it’s about housing, featuring policy, practice and partnership in equal measure. It’s about solutions that work for people and for communities.
Tulsa is an apt setting for a conference of this scope and vision. The 100,000 Homes campaign has recognized the city as a leader among communities making progress in ending chronic homelessness.
At the Alliance’s 2012 National Conference on Ending Homelessness, Greg Shinn from the Mental Health Association in Tulsa presented on the ingredients of Tulsa’s success in the workshop, Chronic Homelessness: Getting to Zero by 2015. According to Shinn, they include:
Community planning and housing investment
Integrated recovery for people experiencing mental health and housing crises
Housing First approaches with person-centered services and coordinated care
A focus on economic impact and sustainability
An... Read More »
Olmstead and the American Disabilities Act
July 31, 2012
In his highlights of the themes of our 2012 National Conference, our Vice President Steve Berg touched on the implications of the U.S. Supreme Court’s interpretation of the Americans with Disabilities Act (ADA) in its 1999 Olmstead decision.
The Supreme Court ruled that the Act requires states to grant people with disabilities the choice of where to live, and that states must avoid placing them in living situations that segregate them from the rest of society. The Olmstead decision, and a number of cases that followed, spoke specifically about state Medicaid programs. However, the Olmsteaddecision is about “community integration” broadly, and has continues to shape the ways in which state programs and services promote the rights of people with disabilities, particularly their right to live in the least restrictive settings of their choice.
The Department of Housing and Urban Development (HUD) has an interest in upholding Olmsteadprinciples, as it does all federal fair housing provisions. While HUD’s purview may raise thorny questions about what kinds of housing are suitable for disabled people who are experiencing homelessness, an important, practical implication of the Olmstead decision is that it makes more resources available to house people who are experiencing chronic homelessness.
Recently, HUD published guidance about the role of public housing agencies (PHAs) in reducing inappropriate institutionalization of persons with disabilities. It is worth... Read More »
25 years after McKinney-Vento
July 23, 2012
This past Sunday, July 22, marked 25 years since President Ronald Reagan signed into law the Stewart B. McKinney Homeless Assistance Act, named after congressman from Connecticut who poured a lot of his time and energy into doing something about what was then the new problem of mass homelessness. The final vote in Congress was 65-8 in the Senate and 301-115 in the House. Years later the Act was renamed the McKinney-Vento Homeless Assistance Act, adding the name of Bruce Vento, a congressman from Minnesota whose commitment to the issue matched Representative McKinney’s.
Everyone involved in getting the act passed regarded it as a first step. The bill provided funding that allowed program operators to try out a variety of approaches to solving the problem. With these resources, for more than 10 years, program operators around the country worked to construct an impressive array of shelters, supportive services, and temporary and permanent housing.
Yet when a major federal research study in the late 1990s showed that the number of people experiencing homelessness had not gone down, few people were surprised. If anything, even more people were homeless at that time than in 1987, the year the act was signed into law.
The new resources and new programs had allowed advocates to improve the lives of individuals experiencing homelessness and serve communities where homelessness existed, but the problem of homelessness remained. So a movement to end homelessness began.
It started in the late 1990s and pic... Read More »
Congressional Caucus discusses trend of violence
July 12, 2012
Today’s post was written by Christian Brandt, Federal Policy Intern for the Alliance.
Chances are you’ve heard about the recent instances of violence against homeless people. These attacks are part of the often violent reality of life on the street. On Tuesday, July 10, the Congressional Caucus on Homelessness convened to discuss this growing trend of violence against people experiencing homelessness. Among the panelists were Maria Foscarinis, executive director of the National Law Center on Homelessness and Poverty (NCH), Richard Wierzbicki, Broward County Sheriff’s office captain, and David Pirtle, a man who himself was a victim of violence while living on the street. The panel was moderated by Neil Donovan, executive director of the National Coalition for the Homeless.
In the discussion that took place all panelists agreed that the reason such violent incidents have proliferated is the increasingly de-humanizing lens through which the public sees people experiencing homelessness. Evidence of this can be seen in the rash of so-called anti-homeless laws recently passed in Denver and throughout the country, which criminalize homelessness or make being homeless that much more difficult. These laws contribute to the perception that people experiencing homelessness are somehow less deserving of the dignity, rights and freedoms that people with permanent housing enjoy, a perception many of the perpetrators of anti-homeless violence appear to hold.
Between 1999 and 2010, NCH has documented 1,184 acts of violence by housed perpetrators against people experiencing homelessness.
Following a brief video featu... Read More »
Is the Obamacare Glass Half Empty or Half Full?
July 10, 2012
What does the Supreme Court decision on the Affordable Care Act mean for communities poised to use new Medicaid funding to bolster their homeless assistance? First and foremost, communities have to engage more intensively with the state policymaking process – this, actually, was true before the ACA ruling came down. And it will be true no matter what the results of elections in November.
Since the decision, we now know that Medicaid will not expand nationally to cover virtually all uninsured people who earn less than $15,000. Therefore, the presumption no longer holds that virtually all people experiencing chronic homelessness will be able to enroll in Medicaid beginning in 2014. But states do have the option to expand in 2014, taking advantage of substantial federal Medicaid subsidies to do so. The ACA cannot require states to expand their programs, but still offers to pay them 90-100% of the cost of covering all uninsured adult citizens who earn around $15,000 or less annually.
Access to health care services – including behavioral health and recovery support – can be a key part of successful housing outcomes for the 107,000 people who experience chronic homelessness on any given night. Without funding for health care, many communities struggle for sustainable solutions – specifically, adequate permanent supportive housing (PSH), which is proven effective to address chronic homelessness. Since Congress passed the ACA in 2010, homeless assistance systems have anticipated the Medicaid expansion – to help individuals and to enhance safety net capacity.
Full Medicaid coverage will not be a ... Read More »
Supportive Housing and Medicaid – Moving the Agenda in States
June 11, 2012
Leaders and innovators in supportive housing convened in Chicago last week for a multi-faceted look at integrating housing and health care. The Leadership Forum, sponsored by the Corporation for Supportive Housing, was also the occasion for the release of a “business case” for states to tap Medicaid to pay for key services in permanent supportive housing. The presenters at the day-long conference and the paper on the business case speak to recent innovations with health care and supportive housing -- demonstrating what’s possible under the Affordable Care Act, and what’s actually happening in communities where state government and homeless providers are proactive.
Two stand-out ACA provisions enable homeless advocates to persuade state policymakers that supportive housing is a worthwhile Medicaid investment.
First, the “health home” benefit can be a good vehicle for funding care management and service coordination, services that make supportive housing viable as a strategy to end chronic homelessness. As the Forum audience heard, a Medicaid health home is a unique concept that has to be understood in a health policy context. But once that context is understood, it is easier to bring relevant data and analysis to Medicaid decision-makers. The business case illustrates that if Medicaid pays appropriately for care management via this new benefit, states can expand their service capacity in supportive housing. That’s because Medicaid allows the state to access federal funding to pay a portion of what the state would otherwise hav... Read More »
Ending Chronic Homelessness State by State: Strategies for Medicaid to Make a Difference
May 14, 2012
“States vary” – a top research finding in virtually every field studied inside the Beltway. When it comes to understanding how Medicaid is relevant to ending chronic homelessness, we would like to be more helpful. True, Medicaid’s relevance to ending chronic homelessness in your community depends greatly on the profile of your state. Still, success in another state is worth looking at, along with assessing what can be borrowed effectively. A pre-conference session for early arrivals at the Alliance’s summer conference will offer an opportunity to do just that. The half-day mini-conference is co-sponsored by the U.S. Interagency Council on Homelessness. We will examine several key facets of how to make Medicaid a stronger partner in programs that house and stabilize people who have been chronically homeless.
Homeless Advocates at the Table. One facet is effective engagement at the right time in state health policymaking. How do homeless advocates get the ear of state health care officials before they make decisions that have implications for addressing chronic homelessness in a person-centered way? New York has an inspiring story of supportive housing stakeholders at the table of statewide Medicaid reform -- with results that bolster community-based strategies to end homelessness. In Louisiana, supportive housing is now viewed as a core element in Medicaid’s plans for managing care of behavioral health enrollees. In short, policy gaps have been successfully bridged with stakeholder input at high levels.
Benefits and Payment Policy. Anoth... Read More »
The ACA Can Help Us End Chronic Homelessness
March 27, 2012
On Tuesdays in March, the Alliance has been blogging about the Affordable Care Act (ACA), which was enacted two years ago and is today (literally, today) the center of attention in the U.S. Supreme Court. As we and our partners have pointed out, the ACA is already helping very vulnerable people, including people experiencing homelessness – for instance, through a limited amount of new funding for community health centers. Other changes are coming on-line this year, such as Medicaid health homes, a state option that can help communities do a better job of coordinating health care and homeless assistance.
Still bigger changes are yet to come. If the key Medicaid expansion is upheld as constitutional, chronically homeless and at-risk adults who do not qualify now will have access to Medicaid benefits, starting in 2014. Even then, the promises of the ACA can fall short, if those benefits are not sufficient for people who need housing stability to recover and improve their health status. It is important for homeless advocates to have a voice in designing Medicaid benefits that make that link with concrete solutions when housing is necessary to complete an effective, person-centered care plan.
There is much work to be done. The ACA offers resources and innovative policies. Whatever the outcome in the Supreme Court, homeless advocates will continue to strive for community networks that seamlessly provide supportive housing, primary care and behavioral health services. We know this approach is n... Read More »