Strategic Plan to Address Homelessness Houston Harris County by wuyunyi

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									 Strategic Plan to Address Homelessness
          Houston/ Harris County




Blue Ribbon Commission to End Chronic Homelessness
                              Houston/Harris County
                                          May 2006
Table of Contents




COMPONENTS OF THE 10 YEAR PLAN

  1. Strategic Plan to Address Homelessness……………………………………Tab 1
        a. Context
        b. Synthesis of Research Findings
        c. Strategic Plan Goals
        d. Summary of Year 1 Action Steps
        e. Funding Requirements
        f. Summary of Data Report Findings
        g. Models used to Develop Plan

  2. Summary of System Management Function…………………………………Tab 2


  3. Enumeration and Needs Assessment………………………………………...Tab 3
        a. Enumeration
        b. Community Profile
        c. Profiles of Specific Sub-Populations
        d. Conclusions
        e. Recommendations

  4. Gaps Analysis……………………...………………………………………...…..Tab 4


  5. Rapid Re-housing Demonstration Report………………………………….....Tab 5
       a. Pierce Intervention Evaluation


  6. Open Doors Report………………………………………………………………Tab 6
       a. Rapid Assessment of Needs of Hurricane Evacuees
Blue Ribbon Commission to End Chronic Homelessness




Anna Babin                                  The Honorable Pat Lykos
United Way of the Texas Gulf Coast          Harris County

David Benson                                Anthony Love
Harris County Commissioners Court           Coalition for the Homeless of Houston/Harris County

David S Buck, MD, MPH                       Barry Mandel
Department of Family & Community Medicine   Houston Downtown Alliance
Baylor College of Medicine
                                            Jackie Martin
James Calaway                               J.S. Martin Associates, LP
Center for Houston’s Future
                                            Vickie L. McBride
Robert Eury                                 City of Houston
Central Houston, Inc.                       Department of Housing & Community Development

The Most Reverend Bishop Fiorenza           The Honorable Gordon Quan
The Diocese of Galveston – Houston          Former City Council Member At Large,
                                            Position 2
Skip Kasdorf
Greater Houston Partnership                 Sally Shipman
                                            The United States Interagency Council on
Richard Lapin                               Homelessness
City of Houston                             Region VI Coordinator – Southwestern States

Anna Leal                                   Richard Wilson
Houston Endowment, Inc.                     Operations Specialist, U.S. Dept. HUD
Participating Provider Organizations: Executive Directors Group



AIDS Foundation Houston
            John Huckaby
Catholic Charities of the Diocese of Galveston-Houston
            Joe Rubio
Children at Risk
            Barbara McCormick
City of Houston
            Vickie McBride
Coalition for the Homeless
            Anthony Love
            Anne Thomas
Healthcare for the Homeless-Houston
            Frances Isbell
The Houston Housing Corporation
            Earl Hatcher
            Caroline Zorn Pickens
Houston Veterans Administration Medical Center
            George Castillo
            Vincent Clancy
            David Sands
Mental Health and Mental Retardation Administration of Harris County
            Tom Mitchell
Ryan White Planning Council
            Tori Williams
SEARCH
            Sandy Kessler
            Tao Costa
            Cathy Crouch
Salvation Army
            Major Henry Gonzales
            Major John Jones
Star of Hope Mission
            Randy Tabor
            Gary Brown
The Women’s Home
            Paula Paust
            Debbie Drake
United Way of the Texas Gulf Coast
            Linda O’Black
            Jeff Stys
U.S. Veterans
            Todd Johnson
Research Team


• Enumeration, Needs Assessment and Gap Analysis

        o   Ritalinda D’Andrea, Ph.D. University of Houston Graduate College of Social Work
        o   Cache Steinberg, Ph.D. University of Houston Graduate College of Social Work
        o   Lalita Sen, Ph.D. Texas Southern University

                Supported by the City of Houston Department of Housing and Community
                Development, Houston Downtown Management District, United Way of the Texas Gulf
                Coast and the Michael E. DeBakey Veterans Administration Medical Center

• Pierce Intervention

       o    Ritalinda D’Andrea, Ph.D. University of Houston Graduate College of Social Work
       o    Anthony Love, Coalition for the Homeless

                Supported by the Houston Downtown Management District, City of Houston
                Department of Housing and Community Development, Houston Endowment, United
                Way of the Texas Gulf Coast, METRO, Houston Downtown Alliance and Midtown
                Management District

• Open Doors Assessment

       o    Ritalinda D’Andrea, Ph.D. University of Houston Graduate College of Social Work
       o    Jeff Stys, United Way of the Texas Gulf Coast

                Supported by the Houston Downtown Management District and United Way of the
                Texas Gulf Coast
             STRATEGIC PLAN TO ADDRESS HOMELESSNESS
                    For Houston and Harris County
                   —prevention, intervention, re-housing, stability—
        Submitted by the Blue Ribbon Commission to End Chronic Homelessness
                                            May, 2006

To be homeless, living on the streets, is to carry in your backpack not just all that you own, but
also the heavy weight of misconceptions about who you are, why you live as you do and what it
would take for you to change your circumstances. You walk among the housed but no one
looks directly at you anymore, as though your presence threatens to expose the fragility of
health, mental health, economic security and unnamed, frightening circumstances that color
judgment and choice. Not just yours, but theirs.


Regardless of the context, efforts to confront homelessness consistently seem to try first to
answer the question, “why?” Research from numerous sources reveals a constellation of
factors that surround homelessness. Ultimately, homelessness is most often associated with
situational or generational poverty that is brought about by a range of possible situations.
Among them:
    o Lack of a source of income
    o Lack of affordable housing
    o Substance abuse
    o Disability or illness
    o Mental illness
    o Lack of access to employment
    o Displacement from natural disaster
    o Inadequate access to, availability or efficacy of prevention or intervention services
    o Lack of education
    o Domestic violence
    o Incarceration
    o Return from military service
    o Discriminatory practices in housing and hiring

As communities and policy makers haggle over causes, individuals at risk of homelessness lose
whatever shelter they may have had. This is the scope of “why.” While there are similarities
among individuals, the balance between extrinsic and intrinsic is unique to each and is best
served by very effective individual-level interventions.

Individual-level interventions alone are, however, inadequate to solve the challenge of ending
homelessness. Moving beyond the debate and the limitations requires a more thorough
examination of the phenomenon of homelessness at a level beyond that of the individual.
“What,” “Where” and “Who” questions become more important than the repeated, “Why?”
Examples of these questions include:
    o How many homeless persons live within a particular area?
    o What are their common characteristics?
    o Where do they congregate?
    o What services do they seek and receive?
    o What is the effect of those services?


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   o   What is the portfolio of permanent housing units for low-income and no-income
       individuals?
   o   What long-term accommodations can be made for persons displaced by natural
       disasters?

These queries about populations and sub-populations can lead to public policy, legislative
action, and group-specific prevention and intervention strategies that can be developed and,
along with individual-level measures, can be monitored and assessed as to their impact.
Having asked these and related questions, the Blue Ribbon Commission to End Chronic
Homelessness created a Strategic Plan to Address Homelessness for Houston and Harris
County. What emerged from the questioning is a much clearer understanding of the complexity
involved in prevention of and intervention in homelessness. As shown in the graphic that
follows, the response to homelessness mandates the coordinated response from at least those
service systems illustrated.


                                     Service Systems

                                            Mental health care
                         Supported                                    Substance abuse
                          housing                                         services




                  Affordable                                                        Public
                   housing                                                          health

                                              Homelessness




                      Special
                                                                                  Health
                    populations
                                                                                   care
                     services

                               Employment
                                                                 Justice system
                                 services




Collaboration from each of the service systems shown is essential, and will be the focus of the
public policy, advocacy and outcome assessment efforts associated with implementation of the
Plan. The collaborative efforts are essential to ameliorate the effects of severe cuts in federal
government budgets to all safety net programs, such as supportive social services, substance
abuse treatment, health insurance, education, employment training and placement, and
domestic violence recovery programs. Since prevention funding has been significantly reduced
by at least three of the federal agencies that have traditionally provided services to homeless
persons, alternatives must be developed. In addition, discriminatory housing practices, rates of
homelessness following release from incarceration, and the rising prevalence of substance
abuse and untreated mental illness can only be overcome with a multi-disciplinary response.
Houston has created many such collaborations, and from them a new understanding of
homeless populations has been developed.



                                                   2
Shift in Understanding of Homeless Populations

Models of treatment often assume that the endpoint for clients is the ability to work at jobs that
can sustain them in stable and secure housing, however, as the research upon which this Plan
is based has shown, this assumption is inaccurate. The research found that in order to maintain
permanent housing, 35% of homeless persons will require lifelong, extensive care; 55% will
need on-going contact with at least one service provider, and only 10% are affected by short-
term, one-time homelessness. As shown on Tab 1 of this document, the current Continuum of
Care within which homeless services are provided would be best reconfigured as three
interrelated systems of care to serve each of these groups.

To maintain permanent housing, an estimated 35% of homeless persons require lifelong care
from a range of service providers due to disabilities or conditions that are very debilitating and
intractable. Within this group are persons who have a major mental illness such as
schizophrenia, or are developmentally delayed, or have untreated, severe substance abuse or a
serious medical condition or disability that precludes their ability to work or live in an
unsupervised setting. Services to this population might include intensive case management,
long-term medical care, psychiatric treatment and medication monitoring, substance abuse
treatment, social skills training. All will require supervised, supportive, permanent housing in
clinical and non-clinical settings. It is noteworthy that many of the services provided to this
group are reimbursable through public programs such as Medicaid and HUD-sponsored
housing.

Recidivism among clients in food programs, clinical services and even supported health care is
often interpreted as “treatment failure” and yet, for 55% of clients, continued participation in
these activities is necessary to prevent their future homelessness. Within this group are
persons whose compromises fall into many of the same categories found in the extensive care
group, but with less severity. As long as they maintain continued contact with the system of
care, most will be able to work, at least episodically, and many will be able to live in independent
housing — some in market rate housing and others in residences designated for persons with
low income. In addition to the services listed above, many in this group will benefit from job
training, job placement and asset building services.

Finally, 10% of homeless persons will be able to permanently exit the system of care within a
year if they receive assistance that is focused, re-establishing their financial security. Rental
and utility assistance are examples of the types of services that are useful to this group,
although some also benefit from employment-related services, medical care, and mental health
or substance abuse treatment.

Though most of the efforts and resources of service providers are expended on the chronically
homeless, many of whom fall in the 35% group, service delivery models are too often based on
the service needs of the 10% group. This can leave clients underserved and providers
frustrated with the mandate to accomplish outcomes based on expectations that are not
appropriate to their clients. They are further challenged with a service demand far beyond
current capacity. For example, in 2005 there were approximately 12,000 homeless persons
identified in a point-in-time count, and 51% resided on the streets. At that same time, the
community had access to only 900 supported permanent housing units, and that was prior to
August, 2005, and the onslaught of Hurricanes Katrina and Rita.




                                                 3
Displaced Persons — The New At-Risk Population

To these groups, another emerged when the Houston community received approximately
300,000 evacuees from Hurricanes Katrina and Rita. Of these, 130,000 persons remained
housed in supported housing units, 6 months after their displacement. The persons for the most
part were employed and housed prior to their relocation. What they will require to rebuild their
lives is as yet unknown. What is known is that assistance to evacuees requires a unique
service model, with overlap in homeless services, especially prevention services.

That model emerged as a result of the exceptional collaboration between the private and public
sectors in response to the evacuation. It assumes that the provision of housing is the most
basic service and that non-traditional, non-clinical sites can be procured and supported for a
limited time. On-going communication among providers and with clients as well as monitoring
of the status of clients has kept most people housed since their relocation. New challenges are
arising, as federal support is in jeopardy. While options are being generated, the outcome is
uncertain.

Sustainability System Management and Support

Implementation of this Plan requires the creation of a management system for advocacy,
oversight, assessment and reporting. This is proposed to be a function of the Coalition for the
Homeless under the direction of Board of Directors with defined accountability to the community
at large.

Support of the implementation will necessitate the strategic spending of current levels of funding
for programs and housing that meet standards of care, and represent the practices that are
documented to be effective in preventing homelessness and assisting homeless persons to
stabilize in permanent housing. The infusion of outcome assessment in each aspect of this
Plan will allow for monitoring the return on the investment in each program and provide the
basis for decisions about future spending. This may begin by redirecting current funds to
programs that document the greatest effect for persons at each level of care. It may also
motivate federal and philanthropic sources to increase resources and support the more
coordinated service delivery model that is proposed in the Plan.




                                                4
CONTEXT
The purpose of this Strategic Plan is to provide guidelines to assure that permanent, secure and
safe housing for all eligible persons will be acquired and maintained through the creation and
implementation of: 1) public policies; 2) system management; 3) housing stock; and, 4) effective
social services, public health and economic infrastructures that eradicate chronic homelessness
and prevent and intervene in episodic and intermittent homelessness in a context that is
compassionate, effective and sustainable.

The Plan was developed under the auspices of the Blue Ribbon Commission to End Chronic
Homelessness (BRC). The Commission was formed in April 2004 to collaborate with the
Coalition for the Homeless of Houston/Harris County (Coalition), city and county officials and
service providers to mobilize resources in Houston/Harris County to assure that no one in the
community will be driven to homelessness due to lack of income, support services or access to
affordable housing. As part of their mission, the BRC has overseen the planning process that
will lead to the development of a Strategic Plan to Address Homelessness, which would comply
with the mandate of the Interagency Council.

Members of the BRC include city and county officials, a representative from the Interagency
Council to End Chronic Homelessness and HUD, business leaders, economic development
professionals, philanthropic organizations, a healthcare representative, and the Coalition.
Administrative support to the BRC is provided by United Way. The BRC directed the
development of the Plan to End Chronic Homelessness, advocated for support of homeless
services with relevant planning and policy groups, and generated funding for the Plan.
The BRC was instrumental in the formation of the Executive Directors Group, a collaboration of
directors of agencies that serve homeless persons. This group actively participated in the
collection and interpretation of data from the Enumeration and Needs Assessment of homeless
persons and, with the Coalition, will enact, direct and evaluate the interventions included in the
Plan. These planning groups (BRC, Directors Group, Coalition) created a comprehensive
strategic action plan that is based on social science research and interventions that have been
proven to be effective and sound public policy.

The Plan is based on findings from the following community research studies:

   2005 Enumeration and Needs Assessment of Homeless Persons in Houston/Harris County
   (Section 3 of this report)

   o   This comprehensive study of the service needs, rates of service use and perceptions of
       access involved more than 2,200 currently homeless individuals who were surveyed and
       an additional 100 who participated in focus groups. In addition, providers of services to
       homeless persons participated in focus groups and interviews to report on the service
       and housing resources, gaps and barriers to access. The study also included five
       monthly counts of sheltered and unsheltered homeless persons.

   2005 Resource Gap Analysis (Section 4 of this report)

   o   Data were gathered from provider surveys and secondary sources, such as IRS Form
       990s, federal grant applications, to further assess the resources and gaps in housing
       and services for homeless persons.



                                                 5
2005 Evaluation of the Rapid Re-housing Intervention (Section 5 of this report)

o   Process monitoring and qualitative evaluation were conducted at intake and four weeks
    after a street-based re-housing intervention for chronically homeless persons who were
    residing under the highway overpass at Pierce Street in Houston.

2005 Rapid Needs Assessment of Hurricane Evacuees (Section 6 of this report)

o   A assessment to determine the pre-evacuation status and current perception of basic
    services, social services, health care and mental health care needs of more than 5,200
    heads of households, representing 19,200 individuals was conducted within the first four
    weeks following the evacuation to Houston of survivors of Hurricanes Katrina and Rita.




                                            6
SYNTHESIS OF RESEARCH FINDINGS
From this diverse collection of data, several conclusions can be drawn.

   •   The immediate cause of homeless is poverty, whether generational or situational.
       Poverty results from a constellation of factors that are intrinsic or extrinsic to the
       homeless person. These may include any combination of conditions such as
       unemployment, mental illness, substance abuse, medical conditions, aging out of foster
       care, history of incarceration, re-entry from military service, domestic violence, limited
       education, lack of job skills, discrimination, and faltering economy.

   •   The availability of and access to services has diminished due to severe funding cuts at
       all levels of government across the spectrum of housing options and supportive services.

   •   More accurate data about current resources, expenditures and costs of housing and
       services must be generated to support more effective planning.

   •   When chronically homeless persons were offered housing in either clinical or non-clinical
       settings, none refused and after 30 days, most remained housed.

   •   Within Houston and Harris County, Rapid Re-housing Intervention for more than 34,000
       households (130,000 persons) displaced by Hurricanes Katrina and Rita was
       accomplished with existing community resources and with federal funding.

   •   The resettlement model enacted for Houston’s hurricane evacuees created a replicable
       services model for housing the chronically homeless.

   •   With the variability and limited duration of public support available for persons displaced
       to Houston by the 2005 hurricanes, there remains a risk of dramatic increases in
       homelessness in the region.

   •   Intervention should be developed for the population of homeless persons based on their
       levels of service need or acuity: long-term care for 35% of the population; on-going,
       periodic care for 55% of the population; temporary care for 10% of the population.

   •   To eliminate homelessness, individuals must be able to meet needs at the following four
       levels:
           o Material (housing, food, clothing, transportation, etc.)
           o Social (sense of belonging, friendships, etc.)
           o Income (living wage)
           o Psychological (self-worth, personal responsibility, sense of contribution, etc.)

   •   Homelessness is a multi-faceted public health problem that requires policies and
       intervention at three levels:
           o Community-level interventions (CLI)
           o Group-level interventions (GLI)
           o Individual-level interventions (ILI)

The Plan is a flexible document that will be subject to annual revision based on the findings of
ongoing outcome assessment, documented changes in client need, public will and availability of


                                                7
resources. The planners of this document believe that homelessness can and will be
addressed by the collective efforts of the Houston community, which has well documented the
capacity for compassion, innovation and successful resolution of significant challenges.

Unmet Permanent Housing Needs Analysis

The unwavering goal of this Plan is to address the need for persons who are homeless or at risk
of homelessness to obtain, maintain and sustain permanent housing. Based on the findings of
the Needs Assessment (see Section 3 of this Plan), it was determined that for 10% of homeless
persons (Temporary care group), re-housing would require brief shelter, variable levels of
services, and a possible term in transitional housing. With that help, they would be capable of
self-support with no need for supported housing.

For 35% (Extensive care group) of the 12,000 homeless persons, there is need for extensive
care and lifelong services that include supported permanent housing. For the final 55%
(Ongoing care group), it is assumed that they require some level of care throughout their lives,
but that would range from individuals who require supported housing and services — slightly
less than is required by the extensive care group — to individuals who have no need for
permanent supported housing, but require some level of support services, more like those in the
temporary care group.

For planning purposes, it is assumed 30% of the Ongoing care group would not need supported
housing, though they may require affordable housing. Thus, as shown in the following table,
using the inventory of permanent housing reported in the 2006 Continuum of Care grant, the
unmet housing need as of the date of this Plan is 7,289 beds.

         Number of Homeless person in 2005 enumeration                         12,000


         2006 Inventory of Permanent housing beds                                1,531
         Number of persons in Temporary care group                               1,200
         Number of persons in Ongoing care group who will not
                                                                                 1,980
         need supported housing
                                                   TOTAL Deductions              4,711


                                                   TOTAL unmet need              7,289




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STRATEGIC PLAN GOALS
Assuming the accuracy of this analysis, implementation of the Plan should accomplish the
following goals, as measured by the progress measures included with each. These indicators
will be analyzed annually as part of the HUD Continuum of Care (Super NofA) process and will
be presented to the community in an annual report.

It is important to note that this Plan will be a work-in-progress, as it must be, with refinements
coming with each update from the annual data reports, assessments of client outcome and
changes in the external factors that affect a community’s susceptibility or resilience to
homelessness.

1. Housing and Re-housing
   • Premise:
      o An essential requirement for ending homelessness is the generation of additional
         permanent housing units
             Based on the current statistics, there are approximately 12,000 homeless
             persons in any point in time. Thirty-five percent of these individuals will require
             fully subsidized housing and related services, 55% will require varying levels of
             support over the course of their lifetimes. This Plan proposes to bridge the
             deficits in permanent housing in 2 ways: 1) development of additional scattered
             site and congregate properties each year and, 2) leasing of scattered site and
             congregate properties each year, until an adequate number of housing options
             are secured. These sites will be service enriched at the level determined by the
             need of the clients and funds available.

Goal 1A
   • Permanent housing is the goal of all programs that serve the homeless and those who
      are at risk of homelessness, with the assumption that 35% of clients will need extensive
      care, 55% will be intermittently involved with the service system throughout their lives
      and 10% will need only one-time, short-term assistance, as illustrated in the Houston
      Model to End Chronic Homelessness.
          Progress measures:
              Number of homeless persons as measured by annual street and shelter counts
              and Homeless Management Information System (HMIS) reports of unduplicated
              clients
              Analysis of HMIS data for rates of entry and re-entry into the system of care,
              duration and types of services
              Point in time count to be held during the third week in January
          Year 1 outcomes
              5% decrease per year in number of persons who are homeless as measured by
              point-in-time counts and census reported in HMIS
              100% participation in HMIS of HUD-funded homeless shelter and housing and
              service agencies

Goal 1B
   • The stock of affordable housing will include an adequate number of units including
      Single Resident Occupancy units (SROs) for low-income and no-income residents.



                                                  9
          Progress measures
             Baseline inventory of shelter and housing units, eligibility requirements and
             income status of residents per HMIS and annual surveys conducted by the
             Coalition
             Inventories of shelter and housing units and SROs, eligibility requirements and
             income status of residents per HMIS and annual surveys conducted by the
             Coalition
             Occupancy and rates of clients turned away from housing will be calculated and
             reported annually
          Year 1 outcomes
             An accurate inventory of 100% of permanent housing units will be completed
             within 6 months of ratification of this Plan
             Accurate monthly occupancy rates and the number of clients who were refused
             services will be reported monthly through HMIS by 100% of the HUD-funded
             shelter and housing programs
             200 new units of HUD-supported permanent housing will be included in the 2006
             Continuum of Care grant
             Up to 200 new lease units will be acquired and achieve 100% occupancy within
             12 months of ratification of this Plan
             25% of the non-clinical housing units that follow the less stringent eligibility
             requirement consistent with “housing first” will be available and achieve 100%
             occupancy within 12 months of ratification of this Plan
             Addition of 100 Section 8 vouchers reserved for chronically homeless individuals
             Endorsement of the development plan by the Houston Mayor’s office, the
             Houston City Council and the Harris County Commissioners Court

Goal 1C
   • Resolve HUD findings to once again enable the development of new Single Room
      Occupancy units (SROs)
         Progress measures
             Indication from HUD that sufficient corrective actions have been accomplished
             Number of SROs in development
         Year 1 outcomes
             Request to Houston Housing Authority and City of Houston to report on the
             status of their correction actions with respect to HUD findings
   • Action Steps
         In conjunction with the City of Houston and Harris County, generate an accurate
         inventory of units available for housing persons with low or no income
         Within HMIS, generate an account of client use of housing units, and gaps
         Create an extensive inventory of residential units that can be leased in non-clinical
         settings that can be scaled to client need
         Generate 200 permanent housing units
         Generate 100 leased units for Rapid Re-housing Intervention
         Conduct 4 Rapid Re-housing Interventions within 12 months of ratification of this
         Plan
         Determine number of lease units for year 2
         Advocate for the addition of 100 new Section 8 vouchers reserved for chronically
         homeless individuals
         Create plan to assure that housing units allocated to hurricane evacuees can be
         reassigned for use in either the Rapid Re-housing Intervention or other programs for
         homeless persons


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2. Prevention and Intervention
   • Premises:
      o Quality, inventory and access to support services, based on client level of acuity,
          should be enhanced.
      o Diminished federal support to hurricane evacuees will place a percentage of them at
          risk for homelessness
      o Essential services include at least the following:
              Case management
              Health care
              Employment-related services
              Health insurance
              Prevention services, such as the Zip Code Assistance Ministries (ZCAM)
              Substance abuse services
              Mental health services
              Assured access for eligible clients to mainstream resources
              Targeted services for special needs populations including:
                • Families
                • Domestic violence victims
                • Veterans
                • Disabled persons
                • Youth and children
                • Elderly
                • Releasees from incarceration
                • Chronically homeless persons
                • Persons with HIV/AIDS
              Enhanced outreach
                • Links with street solicitation initiatives
                • Drop-in centers
                • Rapid Re-housing Intervention

Goal 2A
   • Support services will be available and accessible for all clients who require such
      assistance to obtain, maintain and retain permanent housing. Interventions in the Plan
      will be research-based and proven to be effective, such as ‘housing first‘ and the model
      proposed by “Beyond Shelter.”
           Progress measures
               HMIS reports will be generated to determine service types and baseline rates of
               use and access by clients
               Annual service use reports will be generated through HMIS
               Rates at which clients are turned away from services will be calculated and
               reported annually
               Number of persons in supported lease units who are assigned a housing-related
               case manager
           Year 1 outcomes
               $500,000 will be generated by a collaboration of City, County and philanthropic
               sources for case management that will be accessed by homelessness service
               providers through a competitive process
               10% decrease in number of clients who are refused intervention services due to
               lack of funds by service agencies



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              100% of clients who are provided residence in clinical and non-clinical lease units
              as a result of the Rapid Re-housing intervention will be assigned a housing-
              related case manager
              System manager will develop and release an request for proposals for outreach
              coordination

Goal 2B
   • Prevention services will be available and accessible for those in a housing crisis or
      otherwise at risk of homelessness.
         Progress measures
             HMIS reports will be generated to determine service types and baseline rates of
             use and access by clients
             At intake, rates of prevention service by type and frequency of use by newly
             homeless clients will be recorded and reported annually
             Rates at which clients are turned away from services will be calculated and
             reported annually
             Number of persons at risk for homelessness who receive rental and/or utility
             assistance
         Year 1 outcomes
             $500,00 will be generated by a collaboration of City, County and philanthropic
             sources for rental and utility payment assistance that will be accessed by
             homelessness services providers through a competitive process
             10% decrease in number of clients who are refused prevention services due to
             lack of funds by service agencies

Goal 2C
   • Public/private partnerships that address the causes of homelessness will be developed
      with policy makers and providers of mental health care, medical care, substance abuse
      prevention and treatment, health insurance, and housing.
          Progress measures
             In the first year following implementation of the Plan, through collaborations with
             designated policy makers, an inventory of number of service slots in each of the
             above areas, available and accessible to homeless persons will be conducted.
             Through collaborations, annual updates to needs assessments in each of the
             above areas will be conducted
             A collaboratively developed services funding plan will be developed within 24
             months of acceptance of this Plan
             Changes in the number and types of service units and other outcomes
             incorporated into the services funding plan will be conducted annually
          Year 1 outcomes
             Of the 200 new permanent housing units included in the 2006 Continuum of Care
             application, 30% will be designated for homeless clients with diagnosed mental
             health conditions
             All new housing programs, whether leased units or new construction, will
             designate 30% for persons with substance abuse conditions
             Through the Coalition, a conference for public policy makers will be conducted
             that presents the findings of the Plan




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Goal 2D
   • Initiatives will be undertaken to expand the capability for linking clients to services that
      increase their income including: job training and job placement to assure that those who
      are capable will be employed in positions that provide adequate wages, and registration
      for all mainstream services for which they are eligible.
          Progress measures
               HMIS reports will be generated to determine service types and baseline rates of
               use and access by clients
               Rates of employment, 12-month job retention and wages will be calculated for all
               persons who receive job related services within the Continuum of Care agencies
               Rates at which clients are turned away from services will be calculated and
               reported annually
               Change in rates of persons who are newly enrolled in mainstream services that
               increase their income
          Year 1 outcomes
               From the 2005 baseline in HMIS:
                • 10% increase in the number of job training service units for currently
                    homeless persons
                • 10% increase in the number of job training service units for clients identified
                    at risk of homelessness
                • 10% increase in the number of employment services units for currently
                    homeless persons
                • 10% increase in the number of employment services units for clients
                    identified at risk of homelessness
                • 10% increase in enrollment of persons who are eligible for mainstream
                    resources
               100% of job placement services will collect data on the annual wage of clients

Goal 2E
   • The risk of a significant rise in homelessness as a result of the cessation of federal
      support for persons displaced to Houston by the 2005 hurricanes will be ameliorated by
      a continuation of the aggressive prevention and re-housing program undertaken by the
      City of Houston, Harris County and local non-profit agencies.
          Progress measures
              Frequency of requests for homelessness prevention services from hurricane
              evacuees
              Frequency of requests for homelessness intervention services from hurricane
              evacuees
              Monitoring of housing status of current residents of sponsored housing units as
              well as those who request housing related services (at-risk persons) quarterly
              after June 2006
              Rates of stable housing among current residents of sponsored housing units and
              other at-risk persons who request services
              Rates of employment among current residents of sponsored housing units and
              other at-risk persons who request services
          Year 1 outcomes
              100% of homeless services and housing providers will report through HMIS the
              number of hurricane evacuees who request and receive services




                                               13
   •   Action Steps
           The System Manager or designee will collaborate with the City of Houston, Harris
           County and the evacuee Case Management Planning Group to monitor and devise
           alternative strategies for evacuees
           Generate recruitment and training plan for case managers for lease unit residents
           Raise $1 million in new funds for case management and rent and utility payment
           assistance
           Assist in the implementation of the resettlement model sponsored by the
           Administration of Children and Family Services for hurricane evacuees

3. Public Information, Policy and Accountability
   • Premises:
      o Eliminating the extrinsic factors associated with homelessness requires commitment
           by the community through collaborations among elected officials, government
           agencies, social services providers, health care providers, faith-based organizations,
           philanthropic organizations and the private sector.
      o The public has shown extraordinary generosity in response to hurricane evacuees as
           well as on-going formal programs and spontaneous actions that provide food and
           other services to homeless persons. A program of public awareness could raise
           public awareness and channel these efforts to more effective charitable strategies.
      o Success of this Plan presumes the importance of on-going outcome evaluation and
           revision.

Goal 3A
   • Service providers will participate with the System Manager in the development and
      implementation of standards of care, as necessary and in on-going data collection,
      process monitoring and outcomes assessment.
         Progress measures
             Standards of Care will be developed for all relevant services within 12 months of
             implementation of this Plan
             Annual accounting of rates of compliance with Standards of Care will be
             discussed in the annual report
         Year 1 outcomes
             Upon completion of the Standards of Care, the System Manager will publish for
             providers a phase-in plan for implementation of Standards that includes
             benchmarks
             Within 24 months of approval of this Plan, all agencies that receive Continuum of
             Care funds will demonstrate efforts at complying with the priorities, as measured
             by achieving relevant benchmarks

Goal 3B
   • Enhance support and participation for the Homeless Management Information System to
      better establish housing and services capacity and gaps, and to more accurately gauge
      and monitor outcomes and proxy measures from which cost data can be generated.
          Progress measures
              Services providers’ rates of compliance of HMIS data collection will be tracked
              annually starting with the current year as baseline
              Accuracy and consistency of HUD-mandated performance measures will be
              determined and discussed in the annual report



                                               14
           Year 1 outcomes
              100% of respondents to the 2007 Continuum of Care grant will participate in
              HMIS and be able to provide the Coalition all data and performance measures
              requested by HUD in Exhibit 1 and Exhibit 2 of the grant application.

Goal 3C
   • The City-sponsored on-going campaign to end street solicitation will be linked to public
      awareness, fund-raising and outreach for homelessness prevention and intervention
      services. Information gathered about the number of panhandlers will also be used as a
      an additional data point in calculating unmet need for homelessness prevention and
      intervention services.
          Progress measures
             Changes in number of panhandlers reported by a Mayor-appointed task force
             charged with the intervention at 3, 6 and 12 months following the intervention
             Changes in rates of observation of persons who give money, food or other
             commodities to panhandlers, as reported by the task force
             Increase in donations given for homelessness prevention and intervention
             services, either to a fund established for that purpose or directly to a designated
             service agency
          Year 1 outcomes
             65% of respondents to a random telephone survey will be able to list at least one
             alternative strategy to direct donation to panhandlers, within 30 days of the
             launch of the City’s street solicitation intervention and the simultaneous public
             information campaign
             200 information cards that list homelessness prevention and intervention
             services will be distributed to persons contacted through the street solicitation
             intervention
             50% of church-sponsored programs that provide direct donation to panhandlers
             will participate in a short training about alternative strategies within 6 months of
             launch of the street solicitor intervention

Goal 3D
   • The System Manager will convene an annual conference for providers, client
      representatives and other stakeholders to set the legislative agenda for the year.
          Progress measure
             Prior to the reconvening of the state legislature, a policy agenda will be prepared
             through the office of the System Manager in collaboration with providers, clients
             and other stakeholders and presented to local legislators
          Year 1 outcomes
             100% of prevention and intervention service providers or their designees, who
             receive Continuum of Care funds, will participate in the development of the policy
             recommendations that will be completed for presentation at the first legislative
             session following ratification of this Plan
   • Action Steps
          Convene homeless service providers to generate, ratify and implement standards of
          care as needed for prevention and intervention services
          Using HMIS as a basis, create community-wide unit cost analysis for a list of
          prevention and intervention services deemed by research findings and providers to
          be essential
          Participate in the planning and implementation of the Street Solicitation Initiative
          Develop the Year 1 policy agenda


                                               15
4. Specialized Outreach to Chronically Homeless Persons
   • Premise
      o Chronic homelessness is a complex and multifaceted challenge that is best
          addressed with specialized housing and service programs.

Goal 4A
   • Continue to sponsor with public funds, specially-trained, multi-disciplinary outreach
      teams to offer street-based, harm-reduction services
         Progress measures
             Number of outreach teams and frequency of service delivery to unsheltered
             chronically homeless persons
             Changes in rates of chronically homeless persons who present for agency-bases
             services
             Rates of public funding applied to outreach teams
         Year 1 outcomes
             50% increase in public funding for specialized outreach teams
             10% increase in the number of specialized outreach teams who provide onsite
             services to unsheltered homeless persons (based on an inventory of the
             numbers of teams to be completed within 6 months of Plan ratification)
             1,000 unsheltered chronically homeless persons will complete at least one
             referral to agency-based services, as monitored in HMIS

Goal 4B
   • Each quarter, a Rapid Re-housing Intervention (RRI) will be conducted that targets the
      chronically homeless and includes both clinical and non-clinical housing options, in the
      model of the “Pierce Re-housing Intervention.”
         Progress measures
             Rates and location of re-housing and duration and frequency of homelessness
             for clients in the quarterly intensive interventions will be reported annually
             12-month follow-ups will be conducted and status of clients will be reported
             annually
         Year 1 outcomes
             In each of four RRIs, a minimum of 50 persons will be contacted and re-housed
             for an initial period of 90 days in clinical or non-clinical sites
             At six months post-intervention, at least 85% of persons who were re-housed in
             the RRI intervention will remain in sponsored or independent housing, as
             documented by HMIS reports
             100% of the Rapid Re-housing Interventions outreach teams will include at least:
             one mental health provider, one health care provider, one representative of an
             agency that serves veterans, and one outreach worker trained to interact with
             chronically homeless persons

Goal 4C
   • Drop-in centers that are always open and equipped with basic services will be developed
      throughout the area to provide one type of point-of-entry into services. Use of the
      centers will be promoted by outreach workers to unsheltered homeless persons
          Progress measures
             Number and type of centers that are developed
             Numbers of duplicated and unduplicated clients using the sites will be calculated
             and reported annually



                                              16
              Rates at referral and completion of referrals will be calculated and reported
              annually
           Year 1 outcomes
              Plans for the development, funding and completion of two new sites will be
              drafted within 12 months of ratification of this Plan

   •   Action Steps
           Commitment of an additional $250,000 in public/private funds for the augmentation
           of specialized outreach to chronically homeless persons
           System manager will develop and release an request for proposals for outreach
           coordination

5. Establish a System Management Function (see Section 2 of this report)
   • Premise
       o Exemplary management of the system of housing/shelter supply, services, case
           management and funding will maximize the effectiveness of this Plan to ensure the
           opportunity that individuals will be able to obtain, maintain and sustain housing and
           care.

Goal 5A
   • Effective system management that is a collaboration of the City of Houston, Harris
      County, the Coalition for the Homeless and private sponsors to maintain decision-
      making information, assess situations, make strategic decisions, allocate resources, and
      expand the resources available to prevent and intervene in homelessness.
      o Progress measures
             Number or Rapid Re-housing Interventions that are initiated by the manager and
             conducted by service providers
             Monthly updates of status of Plan outcomes that can be used for strategic
             decision making
      o Year 1 outcomes
             12 monthly reports of Plan outcomes produced by the System Manager
             12 monthly meeting reports of the restructured Homeless Services Coordinating
             Council (see Action Steps that follow)
             A capacity building and technical assistance plan to increase the capability of
             agencies to create permanent supported housing options will be developed by
             System Manager

   •   Action Steps
       o Create System Management function
       o Identify key stakeholders for the Advisory Board who can advance the ongoing
           planning, implementation and funding of Plan
       o Conduct an annual presentation to the City, County and private funders of the Plan
           on the status of outcomes and revisions
       o Restructure the Coalition for the Homeless to serve as System Manager
       o An Executive Management Group for homeless services and housing agencies that
           meet the following criteria will be developed to monitor the progress of the Plan and
           coordinate the Rapid Re-housing Interventions:
               100% participation in HMIS
               Documentation of compliance with Standards of Care (once they are developed
               and adopted)



                                               17
                Participation in the Continuum of Care
                Budgets of at least $1.5 million
       o   The current Homeless Services Coordinating Council will continue to meet monthly
           for the purpose of networking and information sharing
       o   Create technical assistance and capacity building plans

6. Assure sustainable funding for housing options and effective programs
   • Premise:
      o The challenge of funding is multi-dimensional. As the number of homeless persons
         increases, obviously so does the demand for additional services and housing
         options. The research findings suggest, however, that a proportion of current
         expenditures can be reallocated for more effective targeted interventions based on
         client acuity, i.e. level of intensity of service need.

Goal 6A
   • Funding plan for the creation and maintenance of the Strategic Plan will combine
      multiple sources including public, philanthropic and private funds.
         Progress measures
              Accurate accounting of the spending by private and public agencies on
              homelessness prevention and intervention services, shelter and housing
              Development of the budget and methods of funding the components of this Plan
              Improved cost-benefits ratio of homelessness prevention and intervention
              services, shelter and housing
              Documentation of the effectiveness of services marked by decreased demand for
              services, shelter and housing
         Year 1 outcomes
              100% of the Year 1 activities associated with the Plan will be supported by
              adequate funding for implementation

•   Action Steps
    o Using HMIS, audits and other measures, create community-wide unit cost analysis for a
        list of prevention and intervention services deemed by research findings and providers
        to be essential
    o 100% of Continuum of Care agencies or agencies who are funded through the Plan will
        submit an independent financial audit to the System Manager prior to application for
        new funding




                                              18
SUMMARY OF YEAR 1 ACTION STEPS
Goal 1. Action steps
• In conjunction with the City of Houston and Harris County, generate an accurate inventory of
  units available for housing persons with low or no income
• Within HMIS, generate an account of client use of housing units, and gaps
• Create an extensive inventory of residential units that can be leased in non-clinical settings
  that can be scaled to client need
• Generate 200 permanent housing units
• Generate 100 leased units for the Rapid Re-housing Intervention
• Conduct 4 Rapid Re-housing Interventions within 12 months of ratification of this Plan
• Determine number of lease units for year 2
• Advocate for the addition of 100 new Section 8 vouchers reserved for chronically homeless
  individuals
• Create plan to assure that housing units allocated to hurricane evacuees can be reassigned
  for use in either the Rapid Re-housing Intervention or other programs for homeless persons

Goal 2. Action Steps
• The System Manager or designee will collaborate with the City of Houston, Harris County
  and the evacuee Case Management Planning Group to monitor and devise alternative
  strategies for evacuees
• Generate recruitment and training plan for case managers for lease unit residents
• Raise $1 million in new funds for case management and rent and utility payment assistance
• Assist in the implementation of the resettlement model sponsored by the Administration of
  Children and Family Services for hurricane evacuees

Goal 3. Action Steps
• Convene homeless service providers to generate, ratify and implement standards of care as
  needed for prevention and intervention services
• Using HMIS as a basis, create community-wide unit cost analysis for a list of prevention and
  intervention services deemed by research findings and providers to be essential
• Participate in the planning and implementation of the Street Solicitation Initiative
• Develop the Year 1 policy agenda

Goal 4. Action Steps
• Commitment of an additional $250,000 in public/private funds for the augmentation of
  specialized outreach to chronically homeless persons
• System manager will develop and release an request for proposals for outreach
  coordination

Goal 5. Action Steps
• Create System Management function
• Identify key stakeholders for the Advisory Board who can advance the ongoing planning,
  implementation and funding of Plan
• Conduct an annual presentation to the City, County and private funders of the Plan on the
  status of outcomes and revisions
• Restructure the Coalition for the Homeless to serve as System Manager




                                              19
•   An Executive Management Group for homeless services and housing agencies that meet
    the following criteria will be developed to monitor the progress of the Plan and coordinate the
    Rapid Re-housing Interventions:
        o 100% participation in HMIS
        o Documentation of compliance with Standards of Care (once they are developed and
             adopted)
        o Participation in the Continuum of Care
        o Budgets of at least $1.5 million
•   The current Homeless Services Coordinating Council will continue to meet monthly for the
    purpose of networking and information sharing
•   Create technical assistance and capacity building plans

Goal 6. Action Steps
• Using HMIS, audits and other measures, create community-wide unit cost analysis for a list
  of prevention and intervention services deemed by research findings and providers to be
  essential
• 100% of Continuum of Care agencies or agencies who are funded through the Plan will
  submit an independent financial audit to the System Manager prior to application for new
  funding




                                                20
FUNDING REQUIREMENTS
Due largely to the variability of structure within agencies that provide housing and support
services to homeless persons and those at risk, it has proven quite difficult to gather consistent,
accurate data about revenue and the expenses and unit costs of service delivery. The data
upon which the following financial projections are made were elicited from secondary sources
such as IRS Form 990s, annual reports and, to a much more limited extent, the Homeless
Management Information System (HMIS). Thus, the information is incomplete and not verified.
Because the requirement for precise financial outcome measures has been included in this
Plan, and because compliance with those measures will be a factor in determining future
funding of agencies, it is expected that, in Years 2-10 of the implementation of the Plan, far
more accurate financial data can and will be produced. The projections are based on the
assumption of a current spending rate of $66,690,000 per year, which was gathered from the
data sources mentioned above, with an estimated $8,000,000 of additional spending among
agencies for whom data was not available. Need was based on the Unmet Need calculations
(found on page 8 of this document), which were derived from the Needs Assessment findings
and the 2005 Continuum of Care grant application.

The following chart represents the costs associated with the Actions Steps listed for each of the
Goals. A summary of actions for each is provided, along with the estimated required funding
commitment in Year 1. Those tasks that fall within the purview of the System Management
Function are listed as “SMF.” The costs accrued by the development of the 200 units listed in
Goal 1 are expected to be covered by HUD through the 2006 application for Continuum of Care
funds and are, therefore, deducted from the funding requirements that fall to Houston.

                                           YEAR 1 COSTS
                                   Inventory of housing, use, gaps                     SMF
                 Goal 1            Acquisition of 100 lease units for RRI        $1,000,000
                                   200 new permanent housing                     $2,000,000
                                   Collaboration                                       SMF
                                   Case Manager training                             $5,000
                 Goal 2            Case management                                $500,000
                                   Rent/utility assistance                         $500,000
                                   Resettlement                                        SMF
                                   Standards                                           SMF
                                   Cost analysis                                    $20,000
                 Goal 3
                                   Street Solicitation/Public Information          $150,000
                                   Policy agenda                                       SMF
                                   Ratification                                        SFM
                 Goal 4
                                   Outreach                                        $250,000
                                   Create SMF                                      $650,000
                 Goal 5            Stakeholders, Presentation                          SMF
                                   HMIS participation                                  SMF
            Other functions        Data analysis                                    $25,000
                                   Total                                         $5,100,000
                TOTALS             HUD support                                   $1,600,000
                                   To be raised                                  $3,500,000



                                                  21
The charts that follow attempt to project revenues and funding needs, within the limitations
discussed above. The projections for development of housing units/beds, as well as funding
levels, are believed to be achievable. It is critical to note that revisions will occur as better data
is acquired. It is also important to consider that the impact of the housing status of evacuees
from the 2005 hurricanes who choose to reside in Houston for the long term cannot now be
accurately assessed. Finally, at this point it is not recommended that funding be reallocated
from other sources, however, with the clarification of additional data, this option may be
considered.




                                                  22
Strategic Plan to Address Homelessness
Housing Projection Measured in Beds


                               2006
                               Base          2007    2008    2009         2010    2011    2012    2013    2014     2015     2016
Total Inventory

By Housing Type:
Temporary:

Emergency Shelter                 2,417     2,417   2,417   2,417        2,417   2,417   2,417   2,417   2,417    2,417    2,417
Leased Rapid Rehousing Units            0    100     300     700          700     700     700     700     700      700      700
Transitional Housing              2,230     2,230   2,230   2,230        2,231   2,231   2,231   2,231   2,231    2,232    2,232
Subtotal Temporary                4,647     4,747   4,947   5,347        5,348   5,348   5,348   5,348   5,348    5,349    5,349
Permanent:
Leased Housing                        405    605     805    1,005        1,105   1,205   1,305   1,405   1,505    1,605    1,705
Provider Owned Housing            1,126     1,126   1,126   1,226        1,426   1,726   2,126   2,526   2,926    3,326    3,726
Subtotal Permanent                1,531     1,731   1,931   2,231        2,531   2,931   3,431   3,931   4,431    4,931    5,431

Total Beds All Types              6,178     6,478   6,878   7,578        7,879   8,279   8,779   9,279   9,779   10,280   10,780


Beds Added/ Subtracted from Inventory
By Housing Type:
Temporary:
Emergency Shelter                       0      0       0       0            0       0       0       0       0        0        0
Leased Rapid Rehousing Units            0    100     200     400            0       0       0       0       0        0        0
Transitional Housing                    0      0       0       0            0       0       0       0       0        0        0
Subtotal Temporary                      0    100     200     400            0       0       0       0       0        0        0

Permanent:
Leased Housing                          0    200     200     200          100     100     100     100     100      100      100
New Construction Housing                0      0       0     100          200     300     400     400     400      400      400
Subtotal Permanent                      0    200     200     300          300     400     500     500     500      500      500

Total Beds All Types                    0    300     400     700          300     400     500     500     500      500      500




                                                                    23
Strategic Plan to Address Homelessness
Estimated Costs (In Millions)

                                 Base       Rate        2007      2008      2009         2010     2011       2012     2013      2014      2015      2016

Sources:
Existing
Federal/ State/ Local             $34.880             $34.880   $34.880   $34.880   $34.880     $34.880   $34.880   $34.880   $34.880   $34.880   $34.880
Private                           $15.010             $15.010   $15.010   $15.010   $15.010     $15.010   $15.010   $15.010   $15.010   $15.010   $15.010
Philanthropy                       $8.400              $8.400    $8.400    $8.400    $8.400      $8.400    $8.400    $8.400    $8.400    $8.400    $8.400
In-kind                            $8.400              $8.400    $8.400    $8.400    $8.400      $8.400    $8.400    $8.400    $8.400    $8.400    $8.400
Total (from 990s)                 $66.690             $66.690   $66.690   $66.690   $66.690     $66.690   $66.690   $66.690   $66.690   $66.690   $66.690
Total (w/ other)                  $74.690             $74.690   $74.690   $74.690   $74.690     $74.690   $74.690   $74.690   $74.690   $74.690   $74.690

Additional Funding for Plan
Federal                                                $1.600    $3.300    $7.750   $10.500     $13.250   $16.000   $17.000   $18.000   $19.000   $20.000
Local                                                  $3.500    $5.800   $10.850   $12.600     $14.350   $16.100   $16.100   $16.100   $16.100   $16.100
Total                                                  $5.100    $9.100   $18.600   $23.100     $27.600   $32.100   $33.100   $34.100   $35.100   $36.100

Total Existing and New Funding                        $79.790   $83.790   $93.290   $97.790 $102.290      $106.790 $107.790 $108.790 $109.790 $110.790

Uses:
Existing Services & Housing       $74.690             $74.690   $74.690   $74.690   $74.690     $74.690   $74.690   $74.690   $74.690   $74.690   $74.690

New Expense for Plan
System Management Function                             $0.650    $0.650    $0.650    $0.650      $0.650    $0.650    $0.650    $0.650    $0.650    $0.650
Training & Analyses                                    $0.050    $0.050    $0.050    $0.050      $0.050    $0.050    $0.050    $0.050    $0.050    $0.050
Additional Case Management                             $0.500    $0.500    $0.500    $0.500      $0.500    $0.500    $0.500    $0.500    $0.500    $0.500
Rent & Utility Assistance                              $0.500    $0.500    $0.500    $0.500      $0.500    $0.500    $0.500    $0.500    $0.500    $0.500
Panhandling/ Public Campaign                           $0.150    $0.150    $0.150    $0.150      $0.150    $0.150    $0.150    $0.150    $0.150    $0.150
Outreach                                               $0.250    $0.250    $0.250    $0.250      $0.250    $0.250    $0.250    $0.250    $0.250    $0.250
Leased Permanent Units                      $10,000    $2.000    $4.000    $6.000    $7.000      $8.000    $9.000   $10.000   $11.000   $12.000   $13.000
Leased Rapid Rehousing Units                $10,000    $1.000    $3.000    $7.000    $7.000      $7.000    $7.000    $7.000    $7.000    $7.000    $7.000

Capital Outlay New SRO Units                $35,000    $0.000    $0.000    $3.500    $7.000     $10.500   $14.000   $14.000   $14.000   $14.000   $14.000

Subtotal New Expense                                   $5.100    $9.100   $18.600   $23.100     $27.600   $32.100   $33.100   $34.100   $35.100   $36.100

Total Existing and New Expense                        $79.790   $83.790   $93.290   $97.790 $102.290      $106.790 $107.790 $108.790 $109.790 $110.790

Over (under)                                          $0.000    $0.000    $0.000    $0.000      $0.000     $0.000   $0.000    $0.000    $0.000    $0.000




                                                                                    24
SUMMARY OF DATA REPORT FINDINGS
This Plan was developed in the context of several community-based research and evaluation
projects, conducted between 2004 and 2005. The full text of each is found in the subsequent
section of this report. What follows is a brief summary of each.

Enumeration and Needs Assessment

Homeless Population
  • Estimated number of homeless persons in point-in-time count:        12,000 – 14,000
  • Number sheltered in point-in-time count:                                 5,422
  • Housing gap in 2005 point-in-time count (see Tab 4, page 2):             9,439
  • Housing gap with deductions (see Tab 1, page 8):                         7,289
  • Annualized estimate of homeless persons based on 2005 count:            30,000


Demographic Characteristics of Homeless Persons
  • Race:                   65% African-American
  • Ethnicity:              10% Hispanic/Latino
  • Gender:                 51% male
  • Average age:            42
  • Income:                 66% no income; an additional 26.2% less than $10,000
  • Veteran status:         28.3%
  • Duration:               19.7%, less than 3 months; 40.8% greater than 3 years

Example of Rates and Risk Factors in Homeless Persons (based on self-report)
   • Substance abuse:      57.7%
   • Mental illness:       55.5%
   • Incarceration:        24%
   • Domestic violence: 11.3% (of entire population of homeless persons)

Taxonomy of Levels of Care
   • Extensive care:       35% (4,200)
   • Ongoing care:         55% (6,000)
   • Temporary care:       10% (1,200)

Resource Analysis

Resources
   • Estimated current spending for homeless shelter/services:
          o $66.7 million per year (low estimate)
   • Source of funds for homeless shelter and services:
          o Federal/state/local governments:      52.3%
          o Private donations:                    22.5%
          o Philanthropy/Foundations:             12.6%
          o In-kind:                              12.6%




                                             25
Barriers

Homeless persons, service providers, other stakeholders and the relevant professional literature
reveal a range of barriers to accessing services. The following chart, while hardly an exhaustive
illustration, suggests extrinsic risk factors that exit within agencies of government (Community
level), factors that are present for specific populations (Group level) and intrinsic factors that are
faced by individuals (Individual level).

         Community level                       Group level                    Individual level
        —state, county or                     —specific to                     —intrinsic to
        city government—                    sub-populations—                individual clients—
                                       Discrimination
Inconsistent public support               Disproportionate
    Financial                             representation of racial
    Administrative                        groups
    Structural                            Status of illegal
                                          immigrants
                                                                         Intrinsic factors, such as:
Inadequate health care                                                      Substance abuse
   Inadequate support for public                                            Mental health disorders
                                       Hurricane evacuee aftermath
   health programs                                                          Lack of personal
                                          Decreasing availability of
   Cuts in funding to health care                                           empowerment
                                          federal housing support
   support programs
                                          Increasing discontent
   Reduced availability of
                                          among denizens
           Mental health care
                                          Pre-evacuation status
           Medical care
                                          Inability or lack of will to
           Substance abuse
                                          return to previous home
           treatment

Inadequate supply of:                                                    Employment factors
   No-income housing stock             Service provider eligibility        Unemployment
   Low-income housing stock            requirements                        Under-employment
                                                                           Lack of living wage
                                                                         Aging out of the foster
Urban sprawl                           Access to quality education
                                                                         care system
Gentrification of neighborhoods
that housed low-income persons,        Access to job                     Return from military
with out replacement affordable        training/retraining               service
housing
                                       Community support for
Decentralized system of services                                         Domestic violence
                                       families and children
                                       Natural disaster (hurricane,
Inadequate public transportation                                         History of incarceration
                                       flood, etc.




                                                 26
Taxonomy of Interventions
   • Community level (CLI)
      o State, county or city government
   • Group level (GLI)
      o Specific to sub-populations
   • Individual level (ILI)
      o Intrinsic to individual clients

Re-housing Intervention Data

   •   Number of persons re-housed:               172
   •   Number still housed after 30 days:         167


Hurricane Evacuee Data

   •   Number of publicly leased housing units for evacuees:    34,000
   •   Approximate number of persons housed in these units:    130,000
   •   Average pre-evacuation income of evacuees:              $19,500
   •   Percent employed pre-evacuation:                           70%
   •   Percent requesting on-going housing assistance:            84%




                                             27
Models used to develop the Plan
The models from which this Plan was developed are based on best practices from local
agencies, the most current findings of related studies of the Houston metropolitan area, federal
guidelines and the reported experience of successful programs in other areas of the country.

1. Variable Systems of Services

Providers of services to homeless persons have long reported that most of their resources are
spent on people who are chronically homeless and that the outcomes expected for these
clients—re-employment and consistent housing—are virtually impossible to achieve within the
current system of care. Further, there are clients who are episodically homeless, vacillating
between relative stability and crisis. Serving these groups leaves few resources for prevention
or assessment of outcomes and for caring for those who are newly, temporarily homeless.
The experience of providers and in the professional literature, it is apparent that the system of
care could be more effective if it truly acknowledged and accommodated the variations in need
and resources that clients present. It is important to note that in the proposed model, it is not
expected that clients course through the categories. Rather, with effective assessment, it
becomes clear which system of care can best benefit them.

Regardless of the sub-population that clients represent, they can be grouped in to three main
categories, based on the level of interface with systems of service that they require: 1) 35% of
homeless persons will required lifelong, extensive care, 2) 55% will need episodic, varying
levels of on-going assistance, and 3) 10% of the homeless will need temporary, one time
assistance.

Extensive care
This group is composed of individuals who are seriously compromised by severe mental illness,
intractable substance abuse or mental retardation. Most are chronically homeless and are
those clients who, in the past, were typically institutionalized. Based on this study and the
experience of providers, it is estimated that this group makes up about 35% (n=4,200) of the
homeless population. Services to this group must be lifelong and highly structured, with clients
closely monitored. The goal for these clients is that they are assisted in sustaining safe, secure
housing within a system of care. Clients in this group are those served by Safe Haven
programs, such as that administered by MHMRA.

On-going assistance
For this group, contact with a system of care will be for variable length of time at different
intervals, but it will likely be long-term, if not lifelong. These are persons with mental illness or
substance abuse histories who are willing to participate, and capable of participating in
treatment and who, if afforded supportive services related to employment and/or housing, can
maintain both. They may be able to leave components of the system of care for a period of
time, but will remain more stable if case management, at least, is maintained. It is estimated
that this group represents about 55% (n=6,600) of the population. Clients of the DeGeorge
program, administered by the VA, fall into this category.




                                                  28
Temporary assistance
People in this group have most often become homeless because of short-term financial crises—
loss of job, for example—but have the capacity to marshal sufficient resources and, with
assistance, can re-establish their financial viability within about 12–18 months. They comprise
about 10% (n=1,200) of homeless persons, and are served by programs such as the Zip Code
Ministries (ZCAM) that provide rental assistance, utility payments and basic needs in the short
term.

These goals can be accomplished with modification in the current system of services delivery.
A model for ending homelessness must: 1) assess and strengthen the infrastructure, 2) provide
for interventions for at-risk persons, and 3) provide the appropriate level of care for those who
are already homeless.
The model assumes that a client can progress through a system of care appropriate to his or
her resources, and needs to secure permanent housing. The first stage is the Point of Entry.
Within this category are those services wherein clients are introduced into the system of care.
Examples of points of entry are church programs that serve the indigent, outreach programs,
targeted both to those who are homeless as well as those at risk for homelessness. Regardless
of the venue for entry into the system, the primary goal is immediate housing or shelter. Sites
include emergency shelters, transitional programs or ’housing first’ facilities, which are
subsidized rooms or apartments that include case management, but do not require that clients
be participants in a formal treatment or intervention program.
Once housed, persons are provided with a ’support packet’ that includes Medicaid or Gold Card
(Harris County Hospital District service card) as eligibility dictates, an identification card if
needed, a long-term bus pass for use in the local transit system, and whatever other service
eligibility documentation is necessary. When stabilized and willing, the client is then assessed
with both a standardized instrument that conforms to the fields in the Homeless Management
Information System (HMIS) and specialized assessments related to service needs.
At this point, the client can be referred to the service structure that is most appropriate. As with
any such model, this one seems to suggest an elegant and orderly process that is rarely seen in
the real-life provision of services. More likely, clients will be identified and, if the housing
resource base is expanded, will be housed and followed with case management. Depending on
the client’s motivation and resources, he or she may manage to stay housed. The measure of
an effective continuum of care is the degree to which client resources and competencies are
enhanced or supported at a level that enables clients to obtain, maintain and sustain
permanent, safe and secure housing.
No matter how well defined a model for service provision might be, it is nothing more than a
possible guide. What changes the lives of homeless persons is amelioration of poverty and the
concomitant circumstances that lead to it. That occurs only if a person can gather sufficient
personal, financial and relational resources. The role of the service system is to assist the client
in gathering those resources.




                                                29
                                           Permanent housing




                                            Ongoing Care
Extensive Care                            Variable
Lifelong                                  supportive housing               Temporary Services
Highly structured                         supported work options              Back home,
Closely monitored                         Goal: secure housing and            Back to work
Goal: safe, secure                        work, within system of care         Affordable housing
housing, continuation                                                         Goal: out of system
within system of care
                                               Referral:
                                      to appropriate system of care

                                           Client Assessment
                                      Specialized
                                      Standardized


                                                 Initial options
                        ’Housing first‘ facility
                        Shelter
                        Transitional, other continuum of care program
                        Support packet
                           o Medicaid, bus passes, ID cards, etc


                                           Points of entry
                                    Shelters
                                    Meal services
                                    Drop-in centers
                                    Health care (includes mental health)
                                    Day labor sites
                                    Outreach
                                    Justice system
                                    Churches 30
Enhanced Service Delivery
Throughout the course of the various research projects that underpin this Plan, homeless
persons and their service providers reiterated that the most critical element in their ability to gain
access to and effectively use services was the quality of the relationship that they were able to
form with providers. That is the art and humanity of service provision. The science of service
provision involves strategic planning, resource monitoring and implementation of practices that
have been documented as successful with a given population, and in a given context. Too often
providers are forced to plan services based on what might get funded, which may or may not fit
their core competencies or the needs of clients. A potentially more efficacious strategy involves:
    1. Developing programs based on
            a. A theory of behavior or population change
            b. Agency experience
            c. Documented client need
            d. Client satisfaction
            e. Employee competence and satisfaction
    2. Enhancing staff capacity to implement the programs
    3. Defining and monitoring outcomes that identify success
    4. Developing and adhering to a business plan that assures sustainability of the agency
To assure a level of care across agencies, a collaboration of service providers, under the
direction of the Coalition for the Homeless, can create standards of care for all the major
services, shelter and housing programs that serve homeless persons. The degree to which
agencies within the Continuum of Care are invited or required to adhere to the standards will be
the decision of providers and funders.
Once standards are accepted, the community of providers can undertake outcome assessment
to document the effectiveness of their services and enhance program planning. Evaluation can
be conducted with minimal burden to providers by working with the data in HMIS and collecting
and analyzing data submitted in the context of the annual response to the HUD Continuum of
Care grant.

2. Rapid Re-housing of Chronically Homeless Persons
Over the past five years, Houston has embarked on three projects that sought to offer
immediate shelter in clinical and non-clinical settings to persons living under an overpass in the
downtown district of Houston. The most recent of these resulted in the successful housing of
172 chronically homeless individuals.
Findings from the evaluation of this program showed that its success was based on four
components: 1) the availability of non-clinical housing options that were presented in tandem
with a targeted outreach, 2) multi-disciplinary outreach teams that provided on-site triage and
assessment, 3) service-rich, frequent follow-up for clients of the intervention, and 4) a term of
support for at least 90 days. This project validated the ’Housing First‘ model of intervention with
chronically homeless persons.

3. Scale-up of Housing Units in Non-traditional Settings
In the span of less than four weeks, 300,000 persons traveled to Houston as evacuees from
Hurricanes Katrina and Rita. Finding options for immediate and then long-term housing for
more than 130,000 of them has consumed much of the effort of local government. What has




                                                 31
resulted from this is an inventory of hotel, motel, service provider and church-sponsored
housing units that can be reallocated to Houston’s homeless or near-homeless populations.
The community has learned well the exigencies of managing such units, providing case
management to the residents and systems for follow-up and referral. Not only has this validated
“Housing First,” it has also served as the template for the System Management function
proposed in this Plan.
4. Classification of Services Using a Public Health Prevention Model
Given that addressing homelessness requires a complex set of prevention and intervention
services, the developers of the Plan found a model of categorizing levels of services—a
structure often used in public health planning. Within this context, services are grouped
according to the agents of prevention and intervention: 1) community level interventions, 2)
group level interventions, and 3) individual level interventions. As the names reveal, service
delivery is seen as a matrix aimed at each of the levels.
Within this Plan, agencies and organizations are located within the matrix of intervention, as are
the types of services they provide. In addition, an analysis of the gaps in services and barriers
to access are also categorized in this manner.




                                                32
Strategic Plan to Address Homelessness
Housing Projection Measured in Beds


                               2006
                               Base          2007    2008    2009    2010    2011    2012    2013    2014     2015     2016
Total Inventory

By Housing Type:
Temporary:

Emergency Shelter                 2,417     2,417   2,417   2,417   2,417   2,417   2,417   2,417   2,417    2,417    2,417
Leased Rapid Rehousing Units            0    100     300     700     700     700     700     700     700      700      700
Transitional Housing              2,230     2,230   2,230   2,230   2,231   2,231   2,231   2,231   2,231    2,232    2,232
Subtotal Temporary                4,647     4,747   4,947   5,347   5,348   5,348   5,348   5,348   5,348    5,349    5,349
Permanent:
Leased Housing                        405    605     805    1,005   1,105   1,205   1,305   1,405   1,505    1,605    1,705
Provider Owned Housing            1,126     1,126   1,126   1,226   1,426   1,726   2,126   2,526   2,926    3,326    3,726
Subtotal Permanent                1,531     1,731   1,931   2,231   2,531   2,931   3,431   3,931   4,431    4,931    5,431

Total Beds All Types              6,178     6,478   6,878   7,578   7,879   8,279   8,779   9,279   9,779   10,280   10,780


Beds Added/ Subtracted from Inventory
By Housing Type:
Temporary:
Emergency Shelter                       0      0       0       0       0       0       0       0       0        0        0
Leased Rapid Rehousing Units            0    100     200     400       0       0       0       0       0        0        0
Transitional Housing                    0      0       0       0       0       0       0       0       0        0        0
Subtotal Temporary                      0    100     200     400       0       0       0       0       0        0        0

Permanent:
Leased Housing                          0    200     200     200     100     100     100     100     100      100      100
New Construction Housing                0      0       0     100     200     300     400     400     400      400      400
Subtotal Permanent                      0    200     200     300     300     400     500     500     500      500      500

Total Beds All Types                    0    300     400     700     300     400     500     500     500      500      500
  System Management Function: Homeless Housing & Services


Premise

The presence of an exemplary management and coordination of the system of
housing/shelter supply, services, case management and funding will maximize the
effectiveness of this Plan to ensure the opportunity that individuals will be able to obtain,
maintain and sustain housing and care.

Goal

Effective system manager function (Manager) that is a collaboration of the City of
Houston (City), Harris County (County), the Coalition for the Homeless (CFTH) and
private sponsors to maintain decision making information, assess situation, make
strategic decisions, allocate resources, and expand the resources available to prevent
and intervene in homelessness.

System Management Agency

In order to successfully execute a “System Management Function” that is at the core of
the 10 year Plan to End Chronic Homelessness, CFTH would need to expand its current
structure and budget. The current structure supports the existing continuum of care
function quite well, as CFTH is able to regularly organize and produce an application that
generates over $14 million dollars annually. Also, this continuum’s homeless services
provide between 29,000 and 34,000 people annually with housing, food, clothing,
employment assistance and health care. Operated by CFTH, the Homeless
Management Information System (HMIS) is currently used by 56 agencies and 435
licensed users. This web-based system allows the community to determine existing
service gaps among HUD funded homeless service providers, and to better access what
is needed from HUD to close those gaps.

CFTH will serve as the primary operating and fiduciary entity and will participate in a
memorandum of agreement with the City, Harris County, and private supporters to
ensure accountability. CFTH currently operates with 8 professional staff and 2 interns.
CFTH would have to almost double in size to effectively manage/operate this new
system and merge it into the existing continuum of care system. Below are the activities
of this Systems Management Function.


Process
The complexity of this Plan mandates the creation of a centralized management system
that will monitor its implementation through the following functions:

   1. Setting and leading intense strategic direction of services, housing and funding
      toward ending homelessness

The Manager will conduct Strategy Sessions weekly with representatives from the City,
County, private supporters, service providers and clients for the purpose of reporting on
the status of the entire homeless housing/service system status, including monitoring
                                             -1-
outcomes, identifying and solving problems, revising action steps and establishing the
rate of flow of homeless individuals from street to housing and recidivism into
homelessness.

    2. Information and data base management

Through HUD and the CFTH, the community has access to the Homeless Management
Information System (HMIS), a very powerful tool for data collection and reporting. It is
an essential function of the Manager to assure that all service providers who participate
in the Continuum of Care are consistently and accurately entering data about housing
supply, service type and inventory of availability, number of duplicated and unduplicated
clients, number who request housing or support services and are not served, service unit
costs and available funding.

    3. Housing locator function

The Manager will be responsible for assuring the development of new permanent
housing units, rapid rehousing sites, and transitional housing and emergency shelter
beds and collaborate in the quality control and inspection of these and existing units.
Given the outcomes of the Rapid Rehousing Intervention and Hurricane evacuees
resettlement, it is important that an inventory of leased units, tied to fluctuations in client
number be acquired and maintained. In collaboration with its Advisory Board, the
Manager will devise methods to supplement the federally-supported housing voucher
program that is administered by the County as well as those conducted by charitable
organizations.

    4. Cash flow tracking for federal/state/ local funding

A critical function of the System Management process will be the close tracking of the
sources of funds and expenditures for project and programs within its scope. This
accounting has been sorely needed by the community in order to more effectively
determine unit costs per services, project revenues and outlay of funds. Tracking will be
applied to funding sources, recipients, amounts, launch and termination dates and cash
flow. The Manager will also expedite and monitor sub-contracts.

    5. Weekly reports/ monitoring meetings

Through HMIS, weekly reports will be issued that illustrate the: 1) overall counts of
housing units and shelter; 2) occupancy rates; 3) expense estimate; 4) revenue
estimate; 5) cash flow; 6) number of new clients who entered the system of care
through; 7) disruptions in re-housing; 8) progress on Plan outcomes. These reports will
be shared with System Management staff, quarterly with the Advisory Committee and
annually with the City, County and private funders and the community at large.

    6. Problem identification and solving—special needs

An innovative component of the System Management process will be the phasing in of
levels of oversight for services provision—from administrative to fiscal to clinical. At the
administrative level, the Manager will monitor contracts and grants that are awarded
through the Continuum of Care of other entities for which is the fiduciary agent. It will
also oversee and report on the level of achievement of the Plan outcomes and the

                                              -2-
degree of compliance with relevant codes, regulations and the Standards of Care.
Among its first functions will be to provide emergency operating assistance and as
needed assist in the development of action plans that enhance the administrative
capacity of agencies thus reducing the likelihood that emergency aid would be required.

The Manager will also contract for the services such as mobile outreach teams that can
be deployed with the Rapid Rehousing Interventions and the staffing and maintenance
of the drop in centers. Over time, the Manager will employ in-house personnel who can
offer organizational development services with agencies and clinical staff who can
suggest measures to meet outcomes.

   7. Resources/ funds development

Extending its role in the development of resources in which the CFTH already serves as
the liaison to HUD through the development of the Continuum of Care Grant, the
Manager will participate in the generation of new funds by participating with local
government in the budgeting process. In addition, the Manager will consult with
foundations, the religious community and the private sector who are interested in funding
initiatives related to the prevention of and intervention in ending homelessness. In this
roles, the Manager will also create channels for the general public to more effectively
intervene in services to the homeless or those at risk. CFTH will set up a community
fund for homelessness and distribute proceeds to fill strategic cash needs in the system.

   8. Standards of care

In collaboration with provider of housing and services to homeless persons and those at-
risk of homelessness, the Manager will assist in the development of Standards of Care
for related services. These may be patterned after existing Standards and are not
intended to supplant participation in programs such as those required by the Joint
Commission of Accreditation of Hospital Organizations (JCAHO). It will be within the
scope of the System Management function to monitor participating agencies’ compliance
with the Standards and to assist those agencies that have difficulty in meeting their
benchmarks.

   9. Prevention

As has been apparent in the months following the 2005 hurricanes, rapid and effective
crisis intervention greatly facilitates prevention of homelessness. The Manager and
Advisory Board will serve with other first responders to widespread housing related
crises /, such as were seen in the 2005 hurricanes and in Tropical Storm Allison and will
continue to monitor persons who displaced in those disasters. The Manager will
participate with City in assessing long-term needs of the evacuees.

   10. Increasing community will (& opening pockets) to end homelessness

The Manager will be seen as the spokesperson for topics related to homelessness to the
media, civic and community groups and the public at large and will be the source for
accurate information on size of homeless population, the extent of service provided and
the ongoing barriers to service access and unmet needs. They will also administer the
website www.helpthehomelesshouston.com that will provide information for citizens
giving of money, volunteer time, food and clothing.

                                           -3-
Information Used by System Manager:

Housing supply: maintain database inventory of units/ beds through HMIS and possibly
a supplemental database such as a hotel reservation system to monitor at least the
following:
        - Location
        - Shelter/housing type
        - Operator
        - Funding source(s)
        - Case management
        - Maximum occupancy days
        - Transient providers/ informal shelters

Case management & services: capability and supply:
      - Core competencies
      - Standard of care
      - Location(s)
      - On-going service capacity: number of cases

Funding: shelter/housing operator, case manager and service:
      - Expense of provision of units/ beds
      - Expense of case management: $ per client @ standard of care for x time
      - Expense of service per unit at given standard of care
      - Revenue sources including public grant funding
      - Specifics of public grant funding, effective date/ contract term

Homeless individuals: occupancy of units/beds database
          - Name of individual (de-identified in any reports)
          - Social security number and/or other identifiers
          - Profile of individual
          - Location of occupied unit/bed, if sheltered
          - Date of occupancy
          - Date of vacancy
          - Residence after discharge
All databases must provide weekly summary reports. Collectively, these can track flow
of individuals into housing with case management and services. Data quality must be
sufficient to support system management decisions. Use simple spreadsheet databases
initially, if HIMS and other databases are not able to generate reports.

Core System Manager Team:

       -   Team leader (hands-on strategic leader)
       -   Database manager/developer & staff
       -   Service provider liaison/ standards of care expert(s)
       -   Finance/funding/grant performance specialist
       -   Contracts manager/lawyer
       -   Strategic planning/research specialist
       -   Development/communications coordinator
       -   Agency/program relations
       -   Administrative assistant

                                           -4-
Contract Support Team:
      - Data base maintenance and management
      - Outreach/ case management (Mobile Assistance (MAT) Teams)

System Manager Operating Entity:
Coalition for the Homeless is the operating entity and fiduciary agent. Funding
agreements with City, County, and others insure accountability. This will involve re-
composition of the Coalition board.

System Manager Steering Group:
      - Mayor’s Office
      - County Judge/ Commissioners’ Offices
      - Other elected officials
      - Housing & Community Development Department
      - Harris County Community Development
      - City & County Housing Authorities
      - Coalition for the Homeless
      - Local HUD Office
      - Leader of religious community
      - Leader of foundation community
      - United Way
      - Harris County Hospital District & other health
      - Mental Health Authority
      - Major homeless service providers
      - Other service providers (HHS, SSA, TWC, etc.)
      - Law enforcement representatives
      - Business community leaders

Implementation:

Rapid Rehousing Interventions will be launching system management function
       - Four (or a number to be agreed upon) in first year with system in place and
         improvements made between each initiative

Partnership for funding:
       - FEMA
       - Inclusion in HUD Continuum of Care grant
       - Other HUD funding
       - City, County
       - United Way
       - Foundation consortium
       - Downtown District and other management districts




                                           -5-
           Houston/Harris County
             Community Profile
— An Enumeration and Needs Assessment of
 Homeless Persons in Houston/Harris County —




Blue Ribbon Commission to End Chronic Homelessness
   Coalition for the Homeless of Houston/Harris County
                                             May 2005
         Financial Support Provided By:
         City of Houston Department of
      Housing and Community Development
       United Way of the Texas Gulf Coast
         Downtown Management District
Micheal E. DeBakey Veterans Affairs Medical Center
                                     Blue Ribbon Commission

David Benson                                       Anthony Love
Harris County Commissioners Court                  Coalition for the Homeless of Houston/Harris County

David S Buck, MD, MPH                              Barry Mandel
Department of Family & Community Medicine          Houston Downtown Alliance
Baylor College of Medicine
                                                   Jacqueline Martin
James Calaway                                      United Way of the Texas Gulf Coast
Center for Houston’s Future
                                                   Vickie L. McBride
Robert Eury                                        City of Houston
Central Houston, Inc.                              Department of Housing & Community Development

The Most Reverend Bishop Fiorenza                  The Honorable Gordon Quan
The Diocese of Galveston – Houston                 City Council Member At Large,
                                                   Position 2
Skip Kasdorf
Greater Houston Partnership                        Sally Shipman
                                                   The United States Interagency Council on Homelessness
Richard Lapin                                      Region VI Coordinator – Southwestern States
City of Houston
                                                   Richard Wilson
Anna Leal                                          Operations Specialist, U.S. Dept. HUD
Houston Endowment, Inc.

The Honorable Pat Lykos
Harris County




                                               i
Participating Provider Organizations: Executive Directors Group

         AIDS Foundation Houston
                 John Huckaby
         Catholic Charities of the Diocese of Galveston-Houston
                 Anna Babin
                 Joe Rubio
         Children at Risk
                 Barbara McCormick
         City of Houston
                 Vickie McBride
         Coalition for the Homeless
                 Anthony Love
                 Anne Thomas
         Healthcare for the Homeless-Houston
                 Frances Isbell
         The Houston Housing Corporation
                 Earl Hatcher
                 Caroline Zorn Pickens
         Houston Veterans Administration Medical Center
                 George Castillo
                 Vincent Clancy
                 David Sands
         Mental Health and Mental Retardation Administration of Harris County
                 Tom Mitchell
         Ryan White Planning Council
                 Tori Williams
         SEARCH
                 Sandy Kessler
                 Tao Costa
                 Cathy Crouch
         Salvation Army
                 Major Henry Gonzales
                 Major John Jones
         Star of Hope Mission
                 Randy Tabor
                 Gary Brown
         The Women’s Home
                 Paula Paust
                 Debbie Drake
         United Way of the Texas Gulf Coast
                 Linda O’Black
                 Jeff Stys
         U.S. Veterans
                 Todd Johnson


                                    ii
                                    Enumeration Team
The following individuals served as the enumerators for this project. Those team members
listed in bold type also participated in data entry and data validation.

Lorena      Abitante             James       Fuller                 Mary Helen   Merzbacher
Luz         Agah                 Charles     George                 Michelle     Mitchell
Sharon      Alexander            Valicia     Gilyard                Scot         More
Janie       Balderama            Victor      Gonalez                Angela       Moreland
Danny       Bean                 Martin      Graham                 Eugene       Myers
Dennis      Beck                 Julissa     Guerrero               James        Odom
Layla       Becker               Don         Hall                   Virg         Parks
Juana       Benite               Larry       Hamilton               Cervando     Pena
Mike        Blockson             Abraham     Hamilton               Chuck        Roe
Randy       Bratsven             Patricia    Harrington             Eninka       Saidi
Clarence    Brown                Carl        Harris                 Lillian      Salinas
Lawrence    Brown                Victor      Harvey                 Chester      Smith
Jennifer    Carr                 Roland      Harvey                 Iris         Smith
Sherica     Celestine            Sharon      Hewitt                 Maurice      Stringfellow
Tino        Chapa                Patricia    Jackson-Watson         Robert       Tagle
Larry       Cronin               Lana        Lanik                  Maria        Tapia
Melsimon    Davis                Tim         Leighton               Eva          Thibaudeau
Thelma      DeLeon               Crystal     Lovings                Lester       Tone
Ramona      Dixon                Earl        Martin                 Darlene      Whiting
Jonathan    Ellis                Socorro     Martinez               Charles      Williams
Sandra      Elmquist             Lynda       Matthews               Lorenda      Woodard
Barbara     Feliciano            Amalia      Mayorga                Tameika      Woodard
Erica       Fleek-Mallet         Ann         McKown


The following supervisors from the Michael E. DeBakey Veterans Affairs Medical Center
recruited enumerator team members, provided funding and vans and participated in the design
and conduct of each count.
   George Castillo         Vincent Clancy           Clarence Mitchell       David Sands


The Associated Catholic Charities of the Diocese of Galveston/Houston provided the training
and meeting site and many of the vans used for the Enumeration. Catholic Charities staff
comprised the majority of enumerators. Under the direction of Joe Rubio, organizational
support was provided by:
   Rhonda Sepulveda              Mary Helen Merzbacher


SEARCH Mobile Outreach provided route information, outreach workers and enumeration
design. Staff participated in each of the counts. These efforts were led by:
        Don Hall




                                              iii
Acknowledgements




       iv
                                                                       Contents
Blue Ribbon Commission ...........................................................................................................i
Participating Provider Organizations: Executive Directors Group ........................................ii
Enumeration Team.....................................................................................................................iii
Acknowledgements ...................................................................................................................iv
Introduction .................................................................................................................................1
ENUMERATION ...........................................................................................................................2
COMMUNITY PROFILE ...............................................................................................................5
   Housing Status.......................................................................................................................................... 6
     Reasons for loss of housing.................................................................................................................. 7
   Demographic Characteristics .................................................................................................................... 8
     Race/Ethnicity ....................................................................................................................................... 8
     Age range.............................................................................................................................................. 9
     Gender ................................................................................................................................................ 10
     Income range ...................................................................................................................................... 10
     Education level.................................................................................................................................... 11
   Healthcare Characteristics ...................................................................................................................... 12
     Need for medical care and sites where it was provided ..................................................................... 12
     Health insurance status....................................................................................................................... 12
     Medical conditions............................................................................................................................... 14
     Disabilities ........................................................................................................................................... 15
   Service Needs ......................................................................................................................................... 16
   Use of Services ....................................................................................................................................... 17
   Access to Services.................................................................................................................................. 18
PROFILES OF SPECIFIC SUB-POPULATIONS.......................................................................19
     Introduction.......................................................................................................................................... 19
     Summary findings ............................................................................................................................... 20
     How to use the tables and charts........................................................................................................ 20
   Chronically homeless .............................................................................................................................. 21
     Definition ............................................................................................................................................. 21
     Challenges .......................................................................................................................................... 21
     Housing status .................................................................................................................................... 21
     Demographic data............................................................................................................................... 22
     Services: need, use and difficulty of access ....................................................................................... 24
   People with Mental Health Disorders...................................................................................................... 25
     Definitions............................................................................................................................................ 25
     Challenges .......................................................................................................................................... 25
     Housing status .................................................................................................................................... 25
     Demographic data............................................................................................................................... 26
     Services: need, use, difficulty of access ............................................................................................. 28
   People with a History of Substance Abuse ............................................................................................. 29
     Definition ............................................................................................................................................. 29
     Challenges .......................................................................................................................................... 29
     Housing status .................................................................................................................................... 29
     Demographic data............................................................................................................................... 30
     Services: need, use, difficulty of access ............................................................................................. 32
   Veterans .................................................................................................................................................. 33
     Definition ............................................................................................................................................. 33
     Challenges .......................................................................................................................................... 33
     Housing status .................................................................................................................................... 33
     Demographic data............................................................................................................................... 34
     Services: need, use, difficulty of access ............................................................................................. 36
   \



                                                                               v
   HIV/AIDS ................................................................................................................................................. 37
     Definition ............................................................................................................................................. 37
     Challenges .......................................................................................................................................... 37
     Housing status .................................................................................................................................... 37
     Demographic data............................................................................................................................... 38
     Services: need, use, difficulty of access ............................................................................................. 40
   Victims of Domestic Violence.................................................................................................................. 41
     Definition ............................................................................................................................................. 41
     Challenges .......................................................................................................................................... 41
     Housing status .................................................................................................................................... 41
     Demographic data............................................................................................................................... 42
     Services: need, use, difficulty of access ............................................................................................. 44
   Persons Currently Incarcerated or Released from Incarceration............................................................ 45
     Definition ............................................................................................................................................. 45
     Housing status .................................................................................................................................... 45
     Challenges .......................................................................................................................................... 45
     Demographic data............................................................................................................................... 46
     Services: need, use, difficulty of access ............................................................................................. 48
   Marginally housed ................................................................................................................................... 50
     Definition ............................................................................................................................................. 50
     Challenges .......................................................................................................................................... 50
     Housing status .................................................................................................................................... 50
     Demographic data............................................................................................................................... 50
     Services: need, use, difficulty of access ............................................................................................. 52
   Families with Minor Children ................................................................................................................... 53
     Definition ............................................................................................................................................. 53
     Challenges .......................................................................................................................................... 53
     Housing status .................................................................................................................................... 53
     Demographic data............................................................................................................................... 54
     Families represented in special needs populations ............................................................................ 55
     Services: need, use, difficulty of access ............................................................................................. 56
   Youth ....................................................................................................................................................... 57
     Definition ............................................................................................................................................. 57
     Challenges .......................................................................................................................................... 57
     Housing status .................................................................................................................................... 57
     Demographic data............................................................................................................................... 57
CONCLUSIONS .........................................................................................................................60
   Factors That Can Lead to Homelessness............................................................................................... 60
   A Model to Serve Persons Who Are Homelessness .............................................................................. 63
     Defining the problem to be solved ...................................................................................................... 63
     Realistic program planning for clients ................................................................................................. 63
     Support for variable systems of care .................................................................................................. 64
     Implementing evidence-based practices............................................................................................. 65
     Developing standards of care ............................................................................................................. 66
     On-going assessment ......................................................................................................................... 66
RECOMMENDATIONS ..............................................................................................................68
   Public Policy and Planning...................................................................................................................... 68
   Funding ................................................................................................................................................... 68
   Increasing Access to Housing................................................................................................................. 68
   Service Delivery ...................................................................................................................................... 68




                                                                               vi
                          COMMUNITY PROFILE
                 —An Enumeration and Needs Assessment of
                homeless persons in Houston/Harris County—



                                          Introduction
   A man awakens to the sounds of his neighborhood—as he has for the past nine years.
   In a few moments, he will move out to greet his neighbors, grateful that they continue to
   care enough to watch his back. Even the new ones seem to understand how important
   this community is to each of them. They have moved together a few times, most often to
   avoid the police, but this new site, behind the warehouse overlooking the highway, is still
   well hidden even to the folks who work there. Invisible in plain view.
   A young woman resides in a shelter—it is day 3, she has 27 more, needing just that
   small bit of time to reconstitute after the loss of her job meant the lost of her apartment.
   Leaving the shelter, she boards the bus for her first job interview. She understands that
   the impression she gives this potential employer can be the difference between the
   vigilant sleep of congregate living and the restful sleep of a woman at home. Unknown
   to the interviewer, the contact phone number she leaves is that of a community voice
   mail program. Invisible in plain view.
   Another man walks the center of the city from dawn to dusk, in pursuit of a site where he
   might be greeted by name, offered a simple meal and a place to shower. Commuters at
   stoplights, passengers on the Metro line, whiz past. Some may see him, few, if any, can
   or will imagine his day. Invisible in plain view.
   A third-grader is back in class after yet another absence of several days. She is well
   scrubbed; her homework is complete. She assures her teacher that she has not been ill
   and that her parents are fine, that she really is still caught up on all her classwork and
   no, she does not yet remember her home address. Invisible, in plain view.
More than 12,000 citizens of Houston/Harris County are invisible in plain view. They are
individuals and families who are homeless. Although there are personal and societal factors
that can predict the risk of homelessness, each of these persons fell upon their situation
because of a unique set of challenges, decisions and conditions, some of which were within
their control and some beyond. Under the auspices of the Coalition for the Homeless and the
Blue Ribbon Commission to End Chronic Homelessness, from August 2004 through January
2005, researchers launched a coordinated effort to provide a census of homeless persons. In
addition, a comprehensive study was undertaken to invite homeless persons to discuss who
they are, the risks and conditions associated with homelessness, and potential solutions that
would enable those who are homeless to secure and maintain permanent housing. More than
2,500 persons participated in the study. When asked why they were interested in doing so,
most indicated they simply wanted to be heard and seen. The findings of this study are a
chronicle of their words.
   “Yeah, I’ll fill this out, okay, but just because your helper was the first person to look me
   in the eye since I don’t know when. But you tell them the truth of what we say. Make
   them hear us. Make them see us.” — Male, age 42




                                                 1
                                        ENUMERATION
From September 2004 through January 2005, teams of outreach workers and other experts
were deployed to provide a rigorous census of homeless in Houston/Harris County. This
process was unique in four ways:
   1. Composition of the teams
   2. Number of counts
   3. Between-count surveying and observation
   4. Compensation of team members
Unlike most enumeration processes, this study recruited outreach workers and clients from
agencies that serve the homeless. Each team of 3-4 members was composed of at least one
outreach worker and one or two persons who were currently or formerly homeless. Several
team members were also supervisors of homeless services agencies. The team members who
had experienced homelessness were recruited from the Compensated Work Therapy (CWT)
program, administered by the Department of Veterans Affairs (VA) through the Michael E.
DeBakey Veterans Affairs Medical Center. CWT clients were labeled as ‘Experts’ on the teams,
adopted the mantle with diligence and, in partnership with the outreach workers, were largely
responsible for the effectiveness of the counts.
A training program was held at the launch of the project, which detailed the procedures that
would be used including:
        Mapping of territories
        Safety issues
        Signs of encampment
        Characteristics of homeless persons
        Emergency procedures
        Referral procedures
        Methods for respectful approaches to persons being counted
        Non-invasive approaches to encampments
        Use of the enumeration form
        Methods for reporting and collecting remuneration
In the months that followed, each count was preceded by a review of the previous counts, a
report of locations of encampments and congregating sites, techniques in response to weather
conditions, any relevant political changes (such as enforcement of civility ordinances, closing of
a major encampment, news media coverage, etc.). CWT clients were invited to present
information on topics that they believed relevant to the process, and did so at each meeting.
They spoke about methods to engage homeless persons about sites where they were living,
how to find congregating sites, and how not to be perceived as “a ‘narc’ or a cop.”
Between the formal counts, the research team conducted surveys on the streets and were able
to acquaint homeless persons with the Enumeration as well as the Needs Assessment. Team
members became increasingly familiar with encampments and sites where homeless persons
tended to congregate during the day as the study progressed, and with each count were able to
account for a greater number of homeless persons. Because homeless and formerly homeless
men and women were included in the teams, the census gathered data from sites that were new
to outreach workers. Further, persons in encampments and congregating sites became
acquainted with the teams, and on census days were most cooperative in assisting teams in
identifying sites where homeless persons could be found. As the months progressed, the


                                                2
counts grew both in number of persons and in sites found—from nearly 1,000 in about 20 sites
to over 6,000 in well over 100 sites.
Because the weather on the day of the ’count that counted’ was especially inclement, the teams
were diligent in searching for homeless people in and around convenience stores, churches,
hospitals and more remote covered highway overpasses, in addition to the sites they had
identified in earlier counts.
The final count was conducted over 18 hours on January 27, 2005. The final count was 6,218
for unsheltered homeless persons and 5,787 for sheltered homeless persons. These
individuals were found throughout the city and county; some in encampments as large as 200,
others alone and asleep behind buildings, still others walking alone or in small groups.
The chart below combines the data collected in the final count and allocates the numbers within
the sub-populations, based on the proportions determined by the Needs Assessment survey.

 Part 1: Homeless population                        Sheltered           Un-sheltered    Total
                                         Emergency       Transitional
 1. Homeless individuals                    1,769             1,448        5,792        9,009
 2. Homeless families w/children             226                495         258          969
 2a. Persons in homeless families            658              1,547         791         2,996
              TOTAL (line 1 + line 2a)      2,427             2,995        6,583        12,005


 Part 2: Homeless sub-population                    Sheltered           Un-sheltered    Total
 1. Chronically homeless                              1,736                1,866        3,602
 2. Severely mentally ill                             2,604                2,798        5,402
 3. Chronic substance abuse                           2,760                2,966        5,726
 4. Veterans                                          1,638                1,760        3,397
 5. Persons with HIV/AIDS                             729                   784         1,513
 6. Victims of Domestic Violence                      654                   703         1,357
 7. Youth (under 18 years of age)                     1,157                1,244        2,401


The total of persons within the sub-populations exceeds 12,000, since it is possible for a person
to be included in more than one category; i.e., a chronically homeless veteran would be counted
in both categories. Within the group are 2,443 families with children, 409 of which are in
emergency shelters, and 692 in transitional housing. It is estimated that as many as 1,342
families may be unsheltered.




                                                3
The map that follows indicates the approximate distribution of homeless persons in and around
the City of Houston, as recorded during the count that took place on December 16, 2004.




                                              4
                                   COMMUNITY PROFILE
Between August 2004 and January 2005, a comprehensive needs assessment of homeless
persons living in Houston/Harris County was conducted. The study included a survey of 2,294
people, with low to moderate incomes, 1,540 of whom were homeless at the time of their
participation and 20 focus groups with a total of 120 participants. Focus group participants
included homeless persons, providers of services to the homeless, government officials and
caregivers of persons with mental illness. In addition, at least four interviews were conducted
by the lead investigator each time street surveys were undertaken, for a total of 96 interviews.
Two surveys were employed. Survey 1, used to elicit data relevant for the HCD Consolidated
Plani, was administered to 954 persons. Survey 2, used to develop profiles of special needs
populations as designated by HUD, was administered to 1,340 persons. Both surveys included
identical demographic questions that were combined for purposes of providing this information,
so the demographic data are based on the total of 1,540 homeless persons. Data related to
profiles and health care are based on 1,090 homeless persons who completed Survey 2.

                                     Survey 1       Survey 2         TOTAL
                        Housed            504            250             754
                     Homeless             450           1,090          1,540
                         TOTAL            954           1,340          2,294


The Needs Assessment attempted to garner information about the following topics:
   1. What are the demographic characteristics of homeless persons?
   2. What conditions seem to be most highly associated with becoming homeless?
   3. What factors ameliorate the risk of homelessness?
   4. What is the demographic profile of each of the HUD-defined special-needs populations?
   5. What risk factors are present among the marginally housed?
   6. What might prevent homelessness?
   7. What housing-related social services do homeless persons report that they need?
   8. To what degree are social services used by homeless persons?
   9. What barriers exist to accessing and using services?
   10. What gaps in services exist?
Surveys were conducted by the lead investigators with assistance from a data-gathering team of
graduate students, outreach workers, and social service providers not affiliated with any of the
agencies that serve the homeless. Street surveys were conducted by the investigators who
accompanied outreach workers on their routes and into other sites discovered by the
enumerators. No surveying was conducted during the counts.
Survey data was also gathered in emergency shelters, transitional housing programs, drop-in
centers, multi-service centers, single-room occupancy (SRO) sites, clinics, meal providers and
other social service agencies. In addition, teams surveyed guests at the “Super Feast” on
Thanksgiving Day and at a Christmas party for the needy, sponsored by a major faith-based
organization.




                                                5
Housing Status
Of the 2,294 respondents to the survey, 1,590 are currently homeless. Of these, 980 were
homeless one year ago and 626 were homeless five years ago. Thus, 40% of those currently
homeless have been so for at least five years, and 64% for at least one year. Noteworthy is the
finding that, among those who were homeless five years ago, 87% were still homeless one year
ago and among that cohort 94% are now—a rise of 7% from one year ago.
According to the federal Department of Housing and Urban Development (HUD), persons
residing in transitional housing facilities or emergency shelters are considered homeless. The
respondents in this sample reported the following as residences:

                              Site                     Frequency     Percent
                            Shelter                          693       30.4%
                     Abandoned building                       19        0.8%
                              Car                             19        0.8%
                             Street                          471       20.6%
                     Transitional housing                    338       14.8%
                         TOTAL HOMELESS                    1,540       67.5%
                       House/apartment                       349       15.3%
                       With friend/family                    245       10.7%
                 Mental health facility/hospital               3        0.1%
                              Jail                           103        4.5%
                         Not reported                         54        2.4%
                          TOTAL in SAMPLE                  2,294


Among those who are housed, 81 who share a residence with family or friend can be classified
as “marginally housed;” i.e., people who would be homeless had they not been able to ’double
up’—reside in another’s home. They live often in sub-standard housing and report consistent
difficulty finding sufficient funds to pay rent and utility bills and buy food. Because these
housing options are tenuous, such individuals are at high risk for becoming homeless. In fact,
7% report having been homeless one year ago and 5.4% were homeless five years ago.
The graph below shows the duration of homelessness among those who reported being
currently homeless. More than 40% indicated that they have been homeless for more than
three years. Within that group are 479 men and women (31.3% of the sample) who have been
homeless for more than six years, and 88 who have been homeless for more than 10 years.




                                                   6
                                    Duration of homelessness

                                                                          40.8



                      19.7                                   19.2
                                   10.9         9.2




                     < 3 mo      4-6 mo      7-11 mo        1-3 yr       > 3 yr




Reasons for loss of housing
Respondents were asked the reasons that they lost their last stable residence. As indicated in
the chart that follows, the most frequently cited reason was job loss, followed by drug use. It is
important to consider that these attributions are self-reported. Even though the surveys were
anonymous, there may be under-reporting of factors such as drug and alcohol abuse or
domestic violence, which might be considered socially stigmatizing.

                       Reason                Sample            Male         Female
              Job loss                          53%             59%              32%
              Family member job loss            6.0%           5.1%              8.3%
              Could not pay rent                4.8%           4.8%              4.7%
              Disability                        11%           12.4%              7.2%
              HIV/AIDS                          2.6%           2.3%              3.1%
              Domestic Violence                 9.0%           5.8%          19.2%
              Kicked out                      20.9%           21.7%          17.7%
              Drug/alcohol use                26.3%           26.8%          26.4%
              Flood                             4.3%           4.9%              2.1%
              Fire                              1.1%           1.4%              0.5%


The “Kicked out” category encompassed people who were evicted by landlords because of
disruptive behaviors or failure to pay rent, as well as persons who became embroiled in
domestic disputes that resulted in their being forced to leave the residence. While the survey
did not specifically ask if those who lost their housing because of flooding were affected by
Tropical Storm Allison, focus group information supports the assumption that many were.




                                                 7
Demographic Characteristics

Race/Ethnicity
As can be observed in the graph that follows, approximately two-thirds of homeless persons in
the sample are African-American. This is more than three times the representation that would
be expected, since African-Americans are only 18% of the population of Houston/Harris County.
Native Americans are also over-represented, in that they comprise 0.4% of the population of the
region, but 2.8% of the homeless in the sample.


                               Race of Homeless respondents

                            64.9



                                                                   22.1

                                      0.9            2.8                      4.2

                           Afr-Am    As/PI     Nat Am              White     Mixed



Persons of Hispanic origins were 9.9% of the sample population. Of these, 27.3% were female
and the average age of respondents is younger than the general sample (40 overall, 42 for
males and for females, 34). In focus groups, it was disclosed that female adolescents who were
considered by their families to be more acculturated than their more traditional relatives were
sometimes at risk of being shunned or abandoned by their families and, as such, were at higher
risk of homelessness.


                                      Age Range: Hispanics


                                                           29.3
                                             27.2


                                                                     18.4
                                    15.0


                             5.4
                                                                             3.4
                     0.7                                                             0.7

                     <12    13-19   20-29    30-39         40-49     50-59   60-69   70 or
                                                                                     older




                                                     8
Age range
In this study, the average age of the respondents was 43, in a distribution that closely matched
a bell curve. The youngest respondent was 12 and the oldest was 81.


                                      Age Range of Respondents
                                                          42.3%



                                                                  23.1%
                                               20.6%

                                        9.3%
                                                                           3.4%
                    0.1%       0.9%                                                 0.4%

                     <13       13-19 20-29        30-39 40-49     50-59 60-69       70 or
                                                                                    older



Among the study participants were 140 families with 345 children under 18. When the children
are considered, the average age of homeless persons drops to 38.



                                Age range, including children in families

                                                     35.3%




                                                              19.3%
                    17.4%                17.3%


                                7.6%
                                                                          2.8%
                                                                                    0.3%

                    under 20    20-29     30-39      40-49      50-59     60-69   70 or older




                                                      9
Gender
Consistent with most studies, men greatly outnumber women among the homeless: 81% of
those sampled are male, and 19% female. As detailed in the table below, the fact that men
outnumber women by at least two-to-one is consistent by race.

                                               Male                   Female
                    Race                 No.       Percent        No.     Percent
              African-American           812         66.7%        165        57.7%
            Asian/Pacific Islander        10          0.8%          3         1.0%
              Native American             36          3.0%          6         2.1%
                    White                262         21.5%         71        24.8%
                    Mixed                 47          3.9%         16         5.6%
                    Other                 51          4.2%         25         8.7%
                               Total    1218        100.0%        286      100.0%


For both men and women, the highest proportion of homeless persons is among those between
the ages of 40 and 49. The average for men was 45 and, for women, a slightly younger 39.
The chart that follows delineates the age group distribution of respondents by gender.

                                        Male                    Female
                    Age         No.       Percent         No.      Percent
                    <13             1          0.1%           1         0.4%
                   13-19            7          0.6%           7         2.5%
                   20-29           84          7.0%         54         18.9%
                   30-39          235         19.5%         72         25.3%
                   40-49          517         42.9%        113         39.6%
                   50-59          306         25.4%         38         13.3%
                   60-69           50          4.1%           0         0.0%
                 70 or older        6          0.5%           0         0.0%
                       Total     1206        100.0%        285       100.0%


Income range
In this study, the factor most highly predictive of homelessness is poverty. More than two-thirds
of the respondents reported no income. Another quarter indicated an income greater than
$10,000. Focus group data support the findings that homeless persons consistently struggle
with generational and situational poverty. Generational poverty, as the term suggests, is
defined as a condition of persistent, familial poverty that can be associated with unemployment
or underemployment, food anxiety, lower educational achievement, health disparities and
substandard housing. Situational poverty implies a condition wherein a person is unable to earn
or maintain an income. It can be associated with mental health disorders, physical disability,
unemployment or underemployment, or substance abuse.




                                               10
A small percentage of respondents reported income above $21,000. These tend to be women
who become homeless because of domestic violence, persons who lost their jobs, or those who
were unable to continue to work because of mental illness or other disability. The graph that
follows illustrates the income range of homeless participants.



                                    Income range




                  66.1
                                26.3
                                               4.6            1.4           1.6
                  None      $1k-$10K       $11k-              $21k-        >$30k
                                           $20k               $30k



Education level
Increased educational achievement is somewhat preventive of homelessness, as the chart
below illustrates. Fewer homeless persons were educated beyond high school (16.4% of
homeless; 27.4% of housed persons). A greater number of homeless persons completed GED;
of these 19% had done so during a period of incarceration.

                      Highest Level of Education: adult respondents
                                            Housed                    Homeless
             8th grade or below          47           6.4%          132      8.6%
             Some high school           108          14.7%          266     17.3%
             High school graduate       204          27.7%          491     32.0%
             GED                        176          23.9%          387     25.2%
             Some college               129          17.5%          202     13.2%
             College graduate            68           9.2%            49     3.2%
             Graduate education            5          0.7%             7     0.5%
                             TOTAL      737          100.0%      1534       100.0%




                                               11
Healthcare Characteristics

Need for medical care and sites where it was provided
Among homeless persons, 65% reported having needed medical care within the 12 months
prior to the survey date. Of these, 72% were able to receive care at the sites indicated in the
following graph:


                                      Site of Medical Care

                                                51%

                                    40%




                          14%
                                                                       10%
                                                            6%


                      Doc office    Clinic       ER     Urgent care   Hospital



Urgent care clinics were included in the survey for the completeness; however, from interviews
with respondents and in discussion with focus group participants it was determined that there is
a tendency to confuse these clinics with emergency rooms. Thus, the ER calculation of 51% is
likely to be under-reporting by perhaps as much as 6%. It is also important to note that some
ER visits may have been completely appropriate, since those who live on the streets are at
higher risk for trauma and exposure-related health crises, and would also use the ER for
catastrophic events such as heart attack or stroke.

Health insurance status
Not surprisingly, almost half of homeless participants reported having no medical insurance.
The rates of persons on Medicaid/Gold Card reflect the efforts of service providers, particularly
shelter and transitional housing providers, to assure that their clients are receiving benefits for
which they are eligible.




                                                 12
                                 Types of Medical Insurance
              47%

                                                       37%




                                                                  11%
                                         4%
                            1%                                                 1%

              None        Private     Medicare        Medicaid     VA         Other
                                                        GC



The chart below illustrates the gender differences in types of health insurance:

                        Type of Insurance              Male      Female
                               None                     48%         43%
                         Private insurance               1%             1%
                             Medicare                    3%             6%
                       Medicaid/Gold Card               34%         50%
                                 VA                     14%         0.5%


The few persons who reported having private insurance were either women who were newly
homeless because of domestic violence, or men or women who, at some point in the past year,
had access to employer-provided insurance.
Respondents were also queried about their requirements for prescription medications. While
42% indicated that they needed medications daily or often, 73% reported that they skipped
taking them because they were unable to afford them.
Data provided by Healthcare for the Homeless–Houston (HHH) show that 35.9% had no
insurance, 36.5% had a Gold Card, 8.2% had Medicaid and 7.7% had access to VA insurance.
In a compelling finding, HHH notes that of the 220 persons whom they surveyed, “40% had
missed work and 45.9% a meal in order to get healthcare.”ii




                                                 13
Medical conditions
The Community Profile study elicited information from respondents about serious medical
conditions and certain disabilities. It is important to note that the responses are self-reported
and, as such, are likely under-represent the prevalence of each of the conditions, since each
respondent would have to have been diagnosed, remembered that diagnosis, and been willing
to report on the condition in this survey.
Further, several of the conditions covered by survey questions were selected in order to
determine the prevalence of chronic homelessness using HUD criteria, which include the
presence of a disability. The results from these questions are:

                      Health conditions        Frequency           Percent
                            Arthritis                  120           11.0%
                            Asthma                     113           10.4%
                            Cancer                      28            2.6%
                            Diabetes                    78            7.2%
                          Emphysema                     35            3.2%
                         Heart disease                  51            4.7%
                           Hepatitis C                 139           12.8%
                           HIV/AIDS                    137           12.6%
                         Hypertension                  267           24.5%
                         Mental health                 607           55.7%
                       Substance abuse                 629           57.7%
                          Tuberculosis                 110           10.1%


The two most frequently cited conditions were mental health disorders and substance abuse.
Corroboration of the prevalence of HIV/AIDS among the homeless is found in the 2005 Needs
Assessment of Persons with HIV/AIDS conducted by the Houston/Harris County Ryan White
Planning Council. This study fixed the rate of HIV among the homeless at 10% of an estimated
15,000 persons (n=1,569). The Community Profile estimates 12.6% of the 12,000 homeless
persons are HIV positive (n=1,452). However, both of these estimates assume that
respondents are aware of their HIV status.
Over the years, the Centers for Disease Control and Prevention (CDC) has suggested that as
many as 33% of HIV positive persons are unaware of their status. This rate has dropped to
around 25% with the widespread use of HIV rapid testing protocols. Because of the significant
disparity in access to healthcare among the homeless persons, and their increased risk of HIV,
it is justifiable to apply the 33% rate of undiagnosed infections.




                                                14
Disabilities
The Community Profile findings showed that, of people who reported a disabling condition, 85%
indicated that the disability interferes “somewhat” or “greatly” with their activities of daily living.
The chart that follows shows the proportions of respondents with a disability.

                              Condition       Frequency        Percent
                            Vision                     294          27.0%
                                      Blind             18           1.7%
                            Hearing                     74           6.8%
                                       Deaf             15           1.4%
                            Ambulation                 169          15.5%
                              Cannot walk                 9          0.8%
                            Speech                      19           1.7%
                                      Mute                5          0.5%


Any of these disabling conditions can compromise one’s quality of life, but for people who are
homeless they can be life threatening. An inability to walk may mean being unable to find a
meal. Deafness might mean an inability to prevent theft of one’s few possessions.
Impairment associated with the age-related vision changes was widespread and quite apparent
during the course of surveying homeless persons. Surveyors read surveys to respondents and
lent (and eventually gave) respondents corrective lenses that were purchased to enable the
homeless to fill out the surveys. While low literacy was also apparent among the participants, it
was not difficult to differentiate these problems from vision impairments.




                                                  15
Service Needs
From a list of services, respondents designated those that they believed would assist them in
surviving and/or exiting homelessness. This is a critical distinction—regardless of a person’s
ability to seek, acquire and maintain housing, while they are homeless there are basic services
that are essential for them to simply continue to live. The chart that follows indicates the
differences in frequently reported service needs between unsheltered (living on the street) and
sheltered (in emergency shelter or transitional housing) homeless persons, the top six of which
are highlighted in bold type. The calculations are based on the responses of 358 unsheltered
persons, and 632 sheltered persons, who were willing to offer the information.

                             Service             Unsheltered        Sheltered
                  Case management                       68.1%           64.7%
                  Clothing                              84.9%           81.5%
                  Dental                                74.1%           77.6%
                  Emergency shelter                     71.3%           59.9%
                  Food service                          76.9%           70.8%
                  Housing voucher                       82.0%           74.0%
                  Information and referral              76.7%           68.2%
                  Job placement                         76.7%           76.1%
                  Job training                          70.6%           68.9%
                  Medical care                          70.2%           68.6%
                  Mental health care                    57.2%           45.4%
                  Rental assistance                     63.0%           60.2%
                  Substance abuse treatment             51.2%           51.2%
                  Transitional housing                  67.6%           65.5%
                  Transportation                        81.3%           79.6%


Among both unsheltered and sheltered homeless, clothing is cited as the most critical need.
This refers not only to coats and rain gear, but to much more basic needs: socks, shoes, shirts,
pants and undergarments.
Note that housing vouchers and transportation are ranked above food as a need. As will be
shown below, this speaks in part to the degree of access to services, but also to the fact that
transportation is perceived as the key to acquiring services, perhaps being housed, and
maintaining even basic employment.




                                                16
Among the most noteworthy of the findings is the reported need for housing vouchers and
shelter or transitional housing, and the comparison of responses from both sheltered and
unsheltered persons. Interviews and focus group data consistently reinforce the idea that no
one really wants to be homeless; however, many persons fear and cannot live under the
perceived restrictions of shelters or transitional housing programs and thus, believe that they
have no option to unsheltered homelessness.
The high ranking of the need for job placement addresses the myth that homelessness results
from a lack of desire to work.
Dental care’s ranking results from several factors: 1) Medicaid does not cover dental care; 2)
few providers are available to the homeless; and, 3) severe dental diseases are rampant among
homeless persons, as is readily apparent from the most basic observation of the degree of tooth
loss among them.




Use of Services
Rates of service use by unsheltered and sheltered persons are closely aligned, with the
exception of substance abuse treatment, mental health care and transitional housing services,
all of which were used at higher rates by sheltered homeless persons.

                             Service             Unsheltered       Sheltered
                  Case management                       42.9%            43.9%
                  Clothing                              68.3%            63.9%
                  Dental                                35.3%            40.7%
                  Emergency shelter                     45.4%            55.2%
                  Food service                          55.4%            55.7%
                  Housing voucher                       25.8%            27.0%
                  Information and referral              43.2%            44.8%
                  Job placement                         38.0%            39.3%
                  Job training                          32.3%            31.4%
                  Medical care                          45.6%            49.7%
                  Mental health care                    25.5%            34.3%
                  Substance abuse treatment             30.6%            42.2%
                  Transitional housing                  31.5%            40.3%
                  Transportation                        49.8%            53.5%




                                                17
Access to Services
Not surprisingly, unsheltered homeless persons perceive greater difficulty in gaining access to
services than do those who are sheltered. Differences in perceptions about job training and
transportation are especially noted.

                             Service             Unsheltered        Sheltered
                  Case management                      57.0%            50.7%
                  Clothing                             51.9%            43.9%
                  Dental                               70.4%            63.0%
                  Emergency Shelter                    62.4%            48.2%
                  Food service                         51.0%            44.2%
                  Housing voucher                      81.0%            73.4%
                  Information and referral             54.5%            53.6%
                  Job placement                        73.5%            65.1%
                  Job training                         75.1%            65.6%
                  Medical care                         56.0%            47.9%
                  Mental health care                   63.1%            58.1%
                  Substance abuse treatment            44.4%            46.3%
                  Transitional housing                 73.6%            61.6%
                  Transportation                       71.3%            58.3%




                                               18
                       PROFILES OF SPECIFIC SUB-POPULATIONS

Introduction
There is no such entity as, ‘the homeless.’ Rather, there are individuals and families in
particular situations that have resulted in the loss of secure housing. The difference between an
assumption that homeless persons are an undifferentiated group, and one that considers
individual circumstances, may well be the difference between a relatively quick rebuilding of a
life and falling into chronic homelessness. Certainly there are similarities in the situations that
cause a person to become homeless, but a major challenge faced by providers of services and
homeless clients themselves is the stereotyping of those who live in poverty in general, and
those who are homeless, specifically.
Homeless persons are assigned a wide variety of attributes—from laziness, criminality or
sociopathy to victimization, helplessness or incompetence—that often have absolutely nothing
to do with the reality of their lives. Rather, in listening to homeless persons tell their stories, it
becomes clear that there is as much diversity of character and circumstance among those who
are homeless as there is among those who are housed.
The realities of service planning and provision, however, require some aggregating of persons
into categories based on an identifying characteristic. In that context, this section discusses
specific sub-populations, mostly based on HUD categories that segment persons as:
    1. Chronically homeless
    2. Severely mental illness
    3. Substance abusing
    4. Veterans
    5. Victims of domestic violence
    6. Diagnosed with HIV/AIDS
    7. Youth
This study also addresses the services needs of homeless persons who have been incarcerated
and, marginally housed individuals who are at risk of becoming homeless. It is important to
realize that the findings are an aggregation of information that individual respondents offered
about their lives. While hopefully useful in planning, the relevance of these findings to an
individual client, or even group of clients, depends on their personal realities.
Another unfortunate consequence of categorizing clients is that public funding of services can
be threatened. With diminishing allocations comes increased competition. Client sub-
populations are ranked and prioritized, generating the notion that one group of persons is more
or less worthy of assistance than another. It is not the intent of this study to add credence to
any such discussion, but rather to offer insight into what services may be most effective in
addressing the factors that inhibit clients from achieving a quality of life that includes stable,
secure permanent housing.




                                                  19
Summary findings
Several findings are consistent through each of the groups:
      Basic needs—shelter, food, clothing and transportation—are ranked highest in
      importance
      Housing vouchers are ranked higher as a need than either emergency shelter or
      transitional housing
      Dental care is an unmet need and access is perceived as difficult
      Perceptions about difficulty of access to medical care depend on the client group
      Job placement and job training are among the most highly ranked needs, with use and
      perceptions about access varying among groups

How to use the tables and charts
Each of the sub-populations is defined using both the HUD definition and, when different, the
specific definition used in this study. The number and proportion of the study represented by
each sub-group is presented, as well as an estimate of the number within the population of
12,000 homeless persons.
For each sub-population, their housing status and demographic data, as well as service needs,
rates of use and perception of degree of difficulty in obtaining a given service, are presented as
tables. Each table includes both the number of persons who responded to an item and the
corresponding percentage. In the tables that illustrate service status, the percentages
correspond to the following:
    1. Need: percentage of respondents who indicated that they needed a given service
    2. Use: percentage of respondents who indicated that they used a service at least once
    3. Difficult Access: percentage of respondents who indicated that a service was “difficult” or
        “very difficult” to obtain
Quotes were taken from focus groups and street interviews.
   Note: Additional data is available for these sub-populations, and topical reports can be
   developed. To request these reports, please contact the study authors.




                                               20
Chronically homeless

Definition
For purposes of this study, chronic homelessness was defined as being currently homeless,
having been so for longer than 1 year, and with a history of either substance abuse or a mental
health condition. This is less strict than the HUD definition, which requires a person be single,
experienced with more than two instances of homelessness, and have a disability. The more
liberal definition was chosen because data from the focus groups and surveys suggested that
these were sufficient criteria for identifying persons who were, in fact, very compromised; thus, it
was determined that these criteria would yield information far more useful for community and
program planning. In this study, 440 persons (40%) of the sample fit the criteria for chronic
homelessness. Based on the count of 12,000 homeless persons, 4,800 would be chronically
homeless under the study criteria, as compared to 3,600 (30%) according to the HUD definition.

Challenges
It is not surprising that, as shown below, over 39% of those who are chronically homeless are
unsheltered (e.g., street, car, abandoned building), nor that an additional 32.5% were residing in
emergency shelters at the time they responded to the survey. It is logical that people with long
histories of homelessness are most adept at surviving on the streets; however, as shown in
street interviews as well as the focus group data, another reason that chronically homeless
persons tend to remain in the streets is that the majority of their social contacts and friends are
among persons in the encampment where they most often sleep, or among clients of agencies
that provide basic needs such as ’soup kitchens’ or drop-in centers. As one interviewee said:
   “These are the people who watch my back, who would know if I don’t show up that
   something is wrong, maybe real wrong. These are the only people who even know my
   name anymore.” — Male, age 51

Housing status
A noteworthy finding is the reduction from the 1995 enumeration in the number of chronically
homeless persons who find shelter in abandoned buildings. This is consistent in both the needs
assessment and in each of the counts in this study. Very few persons located in vacant
buildings— few of these structures exist and fewer are used by homeless person. At the time of
the 1995 Enumeration of the Homeless, a significant number of persons were found in vacant
residences and commercial buildings throughout the city.

                        Currently staying              Frequency          Percent
                       Transitional housing                    82           20.0%
                              Shelter                         142           34.7%
                 Hospital or mental health facility             1            0.2%
                       Abandoned building                       8            2.0%
                                Car                            12            2.9%
                              Street                          152           37.2%
                              Other                            12            2.9%
                                              Total           409          100.0%



                                                  21
Demographic data

   Race/Ethnicity
Self-reported race of the chronically homeless reveals an even higher proportion of Native
Americans than in the main sample. They represent only 0.4% of the population of the
community, but 2.8% of the homeless and 3.4% of the chronically homeless. It is also
worthwhile to again note that when people report race, there is often confusion about how to
designate that a person is Hispanic, which is classified by HUD as an ethnicity. In this sample,
10.9% are self-reported as Hispanic.

                                Race             Frequency         Percent
                        African-American                    273      62.6%
                        Asian/Pacific Islander                4       0.9%
                        Native American                     15        3.4%
                        White                               100      22.9%
                        Mixed                                18       4.1%
                        Other                                26       6.0%
                                       TOTAL                436      100%


   Age distribution
The average age of chronically homeless persons is essentially the same as that of the general
sample. The distribution is shown below. Of note are the two individuals under 20 years of age
who fit the criteria for chronic homelessness. These are an 18-year-old and a 19-year-old who
both reported more than five years of homelessness and history of substance abuse.
                                Age Range    Frequency     Percent
                                    < 19                2         0.5%
                                   20-29               43         10.1%
                                   30-39              100         23.4%
                                   40-49              176         41.2%
                                   50-59               91         21.3%
                                   60-69               15         3.5%
                                 TOTAL                427         100%


   Gender
From the 427 who responded to this question, it was determined that 82% of chronically
homeless respondents are male and 18% female. Women in this category are among the most
compromised of all homeless persons. According to their survey responses and their narrations
in focus groups and in interviews, they have higher rates of mental health disorders and
substance abuse and are very frequently victims of violence and other crimes. Women tend to
partner with men early in their homelessness in an attempt to find some level of protection; a
strategy that meets with limited success. Trading sex for drugs or money is an often-used
survival strategy.


                                                 22
   Income range
Among the 165 persons who reported any income were a few who cited the sources: Social
Security, sporadic employment and, for one man, family. Almost two-thirds of the respondents
reported no income.
                             Income        Frequency     Percent
                            None                     273          62.3%
                            1,000-10,000             137          31.3%
                            11,000-20,000             18          4.1%
                            21,000-30,000               6         1.4%
                            31,000-40,000               4         0.9%
                                  TOTAL              438          100%


   Education level
Chronically homeless individuals in this sample had slightly higher rates of high school and
college graduation than homeless persons in the overall sample. It is possible that this is due to
a higher percentage of the chronically homeless having been incarcerated, as compared to the
sample.

                                 Education       Frequency         Percent
                            th
                         < 8 grade                           36       8.2%
                         Some high school                    74      16.9%
                         High school graduate               145      33.2%
                         GED                                 91      20.8%
                         Some college                        70      16.0%
                         College graduate                    19       4.3%
                         Post-graduate                        2       0.5%
                                                            437      100%


   Veteran status
It is important to report on the veteran status of the chronically homeless, because of the over-
representation of vets in this population. Among the chronically homeless surveyed, a total of
110 (25.9%) are veterans; however, each step up in age group includes a larger proportion of
those veterans, as shown below.




                                                23
                                 Age           Frequency     Percent
                                20-29                    1      0.9%
                                30-30                   10      9.1%
                                40-49                   48     43.6%
                              50 or older              51      46.4%
                                    Total              110     100%


Services: need, use and difficulty of access
As would be expected, most of the services cited as the greatest need involved basic survival.
That dental care is ranked higher than food services offers a glimpse not only into an important
public health issue, but also into the health and quality of life of individuals. Tooth loss and
reports of pain among those surveyed were noted frequently by the data gathering team.
The need for mental health care and substance abuse treatment was reported almost twice as
often as for both the sheltered and unsheltered sample combined. Relatively high rates of use
of survival services are reported. This underscores the critical importance of such services, not
only to help clients to simply stay alive, but also as significant points of contact with service
providers.
   “Sure, I come here so I can eat, but I come here too because they care about us. Look
   around. It’s raining and cold today, but you don’t see these staff in their warm, dry
   offices. They’re out here with us, real cold and real wet, just like us.”

                    Service                    Need           Use      Difficult Access
         Case management                       68.5%         53.1%                53.8%
         Clothing                              85.3%         72.2%                47.0%
         Dental                                80.2%         41.0%                67.6%
         Emergency shelter                     64.9%         59.0%                55.7%
         Food service                          75.2%         64.1%                48.8%
         Housing voucher                       78.4%         30.5%                77.3%
         Information and referral              70.5%         48.1%                55.0%
         Job placement                         77.9%         42.0%                70.4%
         Job training                          71.5%         34.6%                73.8%
         Medical care                          72.3%         53.6%                53.1%
         Mental health care                    57.7%         41.6%                61.2%
         Rental assistance                     61.7%         31.0%                71.5%
         Substance abuse treatment             56.3%         43.4%                45.2%
         Transitional housing                  71.1%         41.3%                68.5%
         Transportation                        81.5%         58.9%                64.3%




                                                 24
People with Mental Health Disorders

Definitions
This study considered people with mental health disorders to be those who met any of these
criteria: 1) responded “yes” to the “Mental health” item in a list of conditions; 2) wrote in a mental
illness under the “Other” option; 3) indicated that they needed mental health services; 4) used
mental health services. A subset of 605 respondents met these criteria (55.7% of the sample).
HUD specifies severe mental illness as a category within sub-populations. “Severe” is defined
as major depression, bi-polar disorder or schizophrenia. Based on the count of 12,000
homeless persons, 6,684 persons would qualify as mentally ill. According to the HUD definition,
it would be estimated that 5,402 are mentally ill.

Challenges
It is all too obvious that among the homeless are people with severe mental health disorders. In
fact, such persons are the most stereotyped. Severe mental illness, especially if untreated or
under-treated, can render a person utterly incapable of finding or maintaining work, housing,
relationships and even family ties. Co-occurring substance abuse is highly prevalent and, as is
noted in clinical settings, is often an attempt at symptom relief. The most pressing need of the
severely mentally ill homeless person is supportive housing that accommodate the client’s
constellation of symptoms. This is especially challenging to provide, since the very structure
that could potentially benefit the client is that to which he or she can least adjust. These are
very often the clients who are seen as ’not ready for’ or ’unwilling to do’ the programs. Housing
for the not-yet-ready mentally ill client must be a priority.
   “I’ve pretty much managed to burn out everybody. My husband just took the kids and
   left. I don’t even know where they are anymore. He got tired of my depressions and the
   crying and I can’t get out of bed and the not being able to care for the kids. I don’t even
   know where they are. And no program is right for me. I’ve been through, I don’t know,
   lots of ‘em. I hate the meds and nothing’s gonna help.” — Female, age 25

Housing status
Of respondents who reported mental illness, a significantly greater proportion were housed in
transitional housing programs than the proportion in the sample of homeless persons at large;
however, this difference is somewhat due to the selection criteria. People who indicated that
they were mentally ill have, for the most part, been diagnosed as such, and with that diagnosis
comes greater access to treatment programs, including transitional housing. Nonetheless, 33%
of the mentally ill reported living on the street, while the rate for the overall sample was 20.6%.




                                                 25
                      Currently staying                 Frequency            Percent
                     Transitional housing                       115           20.6%
                            Shelter                             227           40.8%
               Hospital or mental health facility                    1         0.2%
                         Jail or prison                              1         0.2%
                     Abandoned building                              7         1.3%
                              Car                                   11         2.0%
                            Street                              184           33.0%
                             Other                                  11         2.0%
                                              Total             557          100.0%


Demographic data

   Race/Ethnicity

                             Race                     Frequency          Percent
                    African-American                          360           60.3%
                    Asian-Pacific Islander                      4            0.7%
                    Native American                           17             2.8%
                    White                                     145           24.3%
                    Mixed                                      28            4.7%
                    Other                                      43            7.2%
                                          Total               597           100%


Of the respondents in this sub-population, 13.1% indicated that they are Hispanic (n=78).

   Age
The average age of persons in this category is 42. A slightly higher percentage of the persons
between 20 and 39 are found among the mentally ill than the sample (34.2% vs. 29.9%).

                            Age Range         Frequency        Percent
                                < 20                      9         1.5%
                                20-29                    70         11.8%
                                30-39                   133         22.4%
                                40-49                   247         41.5%
                                50-59                   119         20.0%
                                60-69                    17         2.9%
                                      Total             595         100%



                                                  26
   Gender
Twenty-one percent (21%, n=123) of homeless persons who reported a mental health condition
are women, compared to 19% in the general population of the homeless. This can be
interpreted as a higher percentage of mental health conditions among homeless women, or it
can be interpreted as a greater likelihood of having been diagnosed, of having used a service,
or a greater willingness than a man has to designate the condition on a survey.

   Income
More people in this group indicated some source of income than in other sub-populations and in
the general sample. Thus, although poverty is most highly associated with homelessness,
access to income alone is not sufficient to prevent homelessness in the mentally ill.

                         Income Range              Frequency       Percent
                         None                            390        64.5%
                         1,000-10,000                    169        27.9%
                         11,000-20,000                    22         3.6%
                         21,000-30,000                    15         2.5%
                         31,000-40,000                     8         1.3%
                         Over 50,000                       1         0.2%
                                    Total                605         100%


   Education level

                               Education            Frequency      Percent
                          th
                       < 8 grade                           60        10.0%
                       Some high school                    98        16.3%
                       High school graduate               177        29.4%
                       GED                                132        21.9%
                       Some college                       106        17.6%
                       College graduate                    28         4.6%
                       Post-grad                               2      0.3%
                                           Total          603        100%




                                                   27
Services: need, use, difficulty of access
Mental health care is indicated as a service need, but it falls well behind the need for basic
services such as food and clothing. Case management also ranks higher than mental health
care; however, as can be seen from the rates of use of services, this population, compared to
the sample, is likely more savvy about systems of care and more aware of the gate-keeping
function of the case manager.

                   Service                   Need            Use       Difficult Access
        Case management                     69.8%          50.0%                  46.3%
        Clothing                            84.8%          69.3%                  52.8%
        Dental                              78.6%          41.0%                  65.4%
        Emergency Shelter                   66.1%          57.2%                  55.9%
        Food service                        75.8%          60.9%                  48.5%
        Housing voucher                     80.0%          29.4%                  77.4%
        Information and referral            69.7%          47.9%                  55.2%
        Job placement                       78.1%          41.7%                  69.5%
        Job training                        70.7%          32.8%                  72.5%
        Medical care                        72.0%          51.8%                  52.1%
        Mental health care                  59.4%          40.7%                  60.7%
        Rental assistance                   64.2%          29.5%                  73.4%
        Substance abuse treatment           53.5%          39.9%                  47.3%
        Transitional housing                66.7%          38.1%                  68.8%
        Transportation                      82.4%          55.5%                  64.9%




                                               28
People with a History of Substance Abuse

Definition
Persons were identified as having a history of substance abuse by meeting any of these criteria:
1) responded “yes” to the “Substance abuse” item in a list of conditions; 2) wrote in a substance
abuse under the “Other” option; 3) indicated that they needed substance abuse treatment
services; 4) used substance abuse treatment services. In this data set, 630 met the criteria.
HUD adds the restriction of chronic use in their definition of the sub-population of people with a
history of substance abuse. This study deducts 10% from the 57.7% of respondents who met
the study criteria to estimate the statistic based on HUD definition. Based on the count of
12,000 homeless persons, 6,684 meet the study criteria for substance abuse and 5,726 meet
the HUD criteria.

Challenges
Even more stereotyped than the mentally ill homeless person, and assigned the most blame for
his or her condition, the person with a history of substance abuse presents with numerous
challenges. As stated earlier, rates of substance abuse co-occur with mental illness, are higher
among those who have served in the military, and are higher after a person becomes homeless
for other reasons.
According to focus group and interview data, crack cocaine is the most addicting of street drugs
and, alone or in combination with other substances, is one of those most often associated with a
person becoming homeless.
   “Did I want to get off this stuff [crack cocaine] yeah, sure. I looked around. Saw all
   these other dudes. Didn’t see of us knowing how to get off if. I’ve done every kinda
   drug there is and was never homeless. I was a minister. I had a church. Got crack.
   Lost everything. For 10 years on the streets, in jail, everything. Now I’m back. I’m here
   [in a treatment program]. I’m gonna make it. I gotta make it because if I don’t the next
   stop is dead.” — Male, age 48

Housing status
Among those with substance abuse histories, more persons are unsheltered than in the general
sample, more so than in any other population except the chronically homeless, many of whom
also reported current or former substance abuse. As will be shown later, this population has
notable increases in the rate of incarceration.




                                               29
                           Currently staying                Frequency          Percent
                          Transitional housing                         130       22.4%
                                 Shelter                               247       42.5%
                    Hospital or mental health facility                   2        0.3%
                              Jail or prison                             1        0.2%
                          Abandoned building                             8        1.4%
                                   Car                                  14        2.4%
                                 Street                                166       28.6%
                                 Other                                  13        2.2%
                                                   Total               581      100.0%

Demographic data

   Race/Ethnicity
Whites are more represented in this group than in other populations—over 25%. Thirty-two
Hispanics are found in the “Other” category, bringing the reported percentage of Hispanics to
20%.

                                 Race                 Frequency              Percent
                        African-American                         376          60.4%
                        Asian/Pacific Islander                     3           0.5%
                        Native American                          20            3.2%
                        White                                    158          25.4%
                        Mixed                                     25           4.0%
                        Other                                     41           6.6%
                                           Total                 623           100%


   Age range
The average age of 42 for this group is one year younger than the sample average, with larger
percentages found in the all age ranges under 40.

                             Age Range         Frequency           Percent
                                 < 20                       10          1.6%
                                20-29                       70         11.5%
                                30-39                      142         23.5%
                                40-49                      260         42.6%
                                50-59                      111         18.2%
                                60-69                       18          2.9%
                                    Total                  611          100%


                                                    30
   Gender
At 22.3% (n=134), women represent a greater proportion of this group than they do in the
general sample. Males are 77.7% of the group (n=468).

   Income range
There are only slight differences in the income range of those with substance abuse histories
than the general sample, and far less income that in those with mental illness.

                          Income Range           Frequency        Percent
                          None                         396         63.3%
                          1,000-10,000                 176         28.1%
                          11,000-20,000                 30          4.8%
                          21,000-30,000                 13          2.1%
                          31,000-40,000                  8          1.3%
                          41,000-50,000                  1          0.2%
                          Over 50,000                    2          0.3%
                                     Total             626          100%


   Education level:
As with those who are chronically homeless, rates of education beyond high school are higher
than the general sample (16.4% for the sample and 24.2% for the group).

                             Education             Frequency        Percent
                       < 9th grade                           59        9.4%
                       Some high school                      92       14.7%
                       High school graduate              179          28.5%
                       GED                               145          23.1%
                       Some college                      115          18.3%
                       College graduate                      34        5.4%
                       Post-grad                              3        0.5%
                                         Total           627          100%




                                                 31
Services: need, use, difficulty of access
As seen in other sub-populations, basic needs and employment are the most needed services.
Although substance abuse treatment is cited more often as a need and is reportedly used more
frequently than the sample in general, respondents indicated more frequently that access is
difficult.

                   Service                  Need        Use         Difficult Access
        Case management                      68.0%       46.9%                52.7%
        Clothing                             84.0%       67.3%                45.9%
        Dental                               78.8%       39.8%                64.8%
        Emergency shelter                    63.7%       56.3%                53.3%
        Food service                         73.6%       58.9%                48.2%
        Housing voucher                      77.9%       29.2%                76.2%
        Information and referral             70.4%       47.6%                54.8%
        Job placement                        78.6%       41.4%                69.8%
        Job training                         72.4%       32.5%                70.5%
        Medical care                         70.8%       50.6%                50.1%
        Mental health care                   54.4%       37.9%                60.5%
        Rental assistance                    64.2%       29.3%                72.2%
        Substance abuse treatment            60.1%       44.6%                45.1%
        Transitional housing                 68.5%       37.8%                65.6%
        Transportation                       82.1%       54.3%                62.2%




                                              32
Veterans

Definition
Respondents who checked “yes” on the question about veteran status, or “yes” on a question
about eligibility for veteran benefits, or had used veterans services, were counted as veterans.
Almost one-third (28.3%, n=304) qualified. This percentage corresponds with national statistics
that estimate that 30% of the homeless are veterans. Based on the 2005 enumeration, 3,397 of
those counted were veterans.

Challenges
Veterans are a diverse group. Their level of identification with military service depends upon a
wide variety of circumstances, including age, and whether or not they participated in combat. In
this study, among the most vocal and most strongly identified with military service were those
self-reported as Vietnam veterans. In focus groups and interviews, they spoke of the realities of
post-traumatic stress disorder, about which little was known or acknowledged when they first
returned home. According to statistics reported by the Department of Veterans Affairs (VA), a
cohort of veterans take up to 10 years to exhaust personal and public resources prior to
becoming homeless. As seen in this study and reported nationally, young vets who served in
Afghanistan and in the current conflict in Iraq are also among the caseload for programs that
serve homeless veterans.
   “I’ve seen stuff no one should see and done worse. I came home and didn’t talk but I
   drank and fought and drank some more and ended up on the streets. And now I have a
   kid over there in Iraq. How is he gonna do better than me? What’s gonna keep him off
   the streets and off the drugs? Me, that’s what. I’m here with these guys [in a program]
   and for now I’m sober. I’ll help my kid, ‘cause I know and if you haven’t been there you
   can never know.” — Male Vietnam vet, age unknown

Housing status
More veterans in this study were sheltered than not. For those in transitional housing, most
were in programs that were exclusively for veterans. The rate of veterans who were
unsheltered was greater than that of unsheltered persons in the general sample.

                                         Currently staying
                                                      Frequency    Percent
                        Transitional housing                 52     18.4%
                               Shelter                       130    46.1%
                            Jail or prison                     1     0.4%
                        Abandoned building                    3      1.1%
                                 Car                           5     1.8%
                               Street                         82    29.1%
                               Other                           9     3.2%
                                             Total           282   100.0%




                                                 33
Demographic data

   Race/Ethnicity
Though the actual number is low, the percentage of vets who are Native American is ten times
higher than would be expected for the population at large in Harris County (0.4% of the
population is Native American). African-Americans were 67% of the homeless veteran
population and 62% of the study sample. Hispanics comprised 12.5% of the population of
homeless veterans.


                                Race             Frequency     Percent
                        African-American                203     67.0%
                        Native American                  12       4.0%
                        White                            61     20.1%
                        Mixed                            15       5.0%
                        Other                            12       4.0%
                                        Total           303      100%


   Age Range
The average age of a homeless veteran is 47, four years older than the study sample. Of note:
11 men (0.3%) are under the age of 29, and 22 men are older than 60. From focus group data,
it was determined that older veterans have longer intervals and a greater number of episodes of
homelessness.

                           Age Range            Frequency     Percent
                                < 20                     1      0.3%
                                20-29                   10      3.4%
                                30-39                   37     12.5%
                                40-49                  134     45.1%
                                50-59                   93     31.3%
                                60-69                   22      7.4%
                                   Total               297      100%


   Gender
Of the population of homeless veterans, 93.2% are male and 6.8% are female.




                                                  34
   Income range
The income ranges reported by veterans parallel those of the study sample. Several of those
who indicated income between $1,000 and $10,000 were participants in work programs
associated with the VA.



                           Income range             Frequency   Percent
                           None                           186    61.4%
                           1,000-10,000                    92    30.4%
                           11,000-20,000                   16     5.3%
                           21,000-30,000                    5     1.7%
                           31,000-40,000                    2     0.7%
                           4,000-49,000                     1     0.3%
                           Over 50,000                      1     0.3%
                                      Total               303     100%


   Education level
As might be expected due to eligibility requirements, education levels are higher in this group,
especially among the younger participants who entered military service after the end of the
draft.

                                Education             Percent   Frequency
                           th
                       < 9 grade                           19        6.3%
                       Some high school                    21        7.0%
                       High school graduate                91       30.1%
                       GED                                 75       24.8%
                       Some college                        69       22.8%
                       College graduate                    25        8.3%
                       Post-grad                            2        0.7%
                                            Total         302        100%




                                                    35
Services: need, use, difficulty of access
As with most other sub-populations, homeless veterans cite basic needs, dental care and job
placement services as their top priorities. They rank medical care, mental health care and
substance abuse treatment needs higher than other populations, and indicate greater use of
these services.

        Service                             Need            Use      Difficult Access
        Case management                     65.3%         50.0%                51.1%
        Clothing                            83.3%         73.4%                46.6%
        Dental                              74.9%         39.1%                63.6%
        Emergency shelter                   65.7%         62.0%                50.0%
        Food service                        76.0%         63.0%                48.9%
        Housing voucher                     76.9%         32.1%                75.4%
        Information and referral            71.2%         51.2%                52.8%
        Job placement                       75.9%         46.0%                66.8%
        Job training                        67.1%         35.1%                66.9%
        Medical care                        68.4%         53.6%                46.6%
        Mental health care                  53.3%         41.4%                58.3%
        Rental assistance                   62.5%         33.8%                71.2%
        Substance abuse treatment           53.4%         46.9%                42.5%
        Transitional housing                70.6%         43.3%                67.4%
        Transportation                      77.9%         59.8%                61.1%




                                             36
HIV/AIDS

Definition
Through the program, Housing Opportunities for Persons with HIV/AIDS (HOPWA), and through
the Continuum of Care, HUD has allocated funds for a variety of housing-related services to
those who are living with HIV/AIDS, or Persons Living With HIV/AIDS (PLWH/A). The
requirements for access to these services are documented diagnosis and income. As stated
earlier, approximately 12.6% (n=137) of the study sample reported that they were HIV positive.
The criteria for inclusion were having checked the item, “HIV” from a list of medical conditions.
Based on the count of 12,000, 1,513 homeless persons are HIV positive.

Challenges
In addition to the challenges associated with homelessness, PLWH/A must attempt to slow the
progression and impact of an incurable disease that with treatment can be managed, and
without treatment can lead to life-threatening opportunistic infections and death. Even if they
are fortunate enough to gain access to treatment, adherence to the medication regimens
requires adequate nutrition with consistent timing of meals, regular medical and dental care and,
as much as possible, limited exposure to infectious agents that may weaken an already
compromised immune system. This assumes that the PLWH/A is aware of his or her condition.
As stated earlier, as many as 33% of those infected with HIV do not know that they are infected.
This makes exposure to the virus a bigger risk, especially among persons who exchange sex for
money or drugs, or who are injecting drug users.
    “He gave it to me and I’m the one gets thrown out. Can you beat that? He found out
    first, so it’s me that gave it to him in his mind. But I know. I’m lucky so far, I haven’t
    been too sick yet. Yet, right? I didn’t know all about his drugs, well not that [crack use]
    anyway. Maybe I’d have left anyway, but I got no place to go and now this. And you
    can’t tell, because you don’t know they’d tell. [cries] My family don’t even know, never
    will if I can help it.” — Female, age 33

Housing status
Of PLWH/A, an equal number were housed in transitional programs and in shelters. Though
HOPWA funds housing services exclusively for people with HIV/AIDS, the need outweighs the
current options, as with every other sub-population. When questioned specifically about access
to medical care, only 2 of the 28 persons who responded replied that they had been seen by a
physician within the past 12 months—the criterion set by HRSA1 for designation as “in care.”




1
 HRSA: Health Resources and Services Administration—a division of the U.S. Department of Health and
Human Services, the agency that administers Ryan White CARE Act funding.


                                                 37
                           Currently staying               Frequency      Percent
                          Transitional housing                    44       33.8%
                                 Shelter                           43      33.1%
                    Hospital or mental health facility             1        0.8%
                              Jail or prison                       1        0.8%
                          Abandoned building                       4        3.1%
                                   Car                              2       1.5%
                                 Street                            33      25.4%
                                  Other                             2       1.5%
                                                   Total          130     100.0%


Demographic data

   Race/Ethnicity
Native Americans are over-represented in this category also, as are African-Americans, though
to a slightly lesser degree than in other populations. Hispanics are 15% of this group. These
findings align with national statistics, which consistently report that people of color are
disproportionately represented in both the incidence and prevalence of HIV.

                                 Race               Frequency       Percent
                        African-American                     80         59.7%
                        Asian/Pacific Islander                1         0.7%
                        Native American                       8         6.0%
                        White                                31         23.1%
                        Mixed                                10         7.5%
                        Other                                 4         3.0%
                                           Total            134         100%


   Age
The average age of PLWH/A is 39, 4 years younger than the sample average of 43. Nationally,
the greatest proportion of cases of HIV is found in persons between the ages of 20 and 35,
though the trend is toward increase among even younger people.




                                                   38
                             Age range       Frequency          Percent
                                  < 20                 2          1.5%
                                  20-29               20         14.7%
                                  30-29               34         25.0%
                                  40-49               63         46.3%
                                  50-59               16         11.8%
                                  60-69                1          0.7%
                                                     136          100%


   Gender
Women comprise a much larger percentage of this group, which is consistent with national
statistics. In this study, females were 33.8% of the group (n=44) and 66.2% were male (n=86).

   Income range
Income levels are consistent with those of the sample of homeless persons in general.

                           Income range        Frequency           Percent
                           None                            82       59.9%
                           1,000-10,000                    40       29.2%
                           11,000-20,000                   10         7.3%
                           21,000-30,000                    1         0.7%
                           31,000-49,000                    2         1.5%
                           Over 50,000                      2         1.5%
                                     Total             137           100%


   Education level
That almost 15% of the group reports less than a high school education is noteworthy, and
requires more exploration. The population reports 54.6% substance abuse and 57.7% mental
illness, and 16% have served time in jail or prison; though these are not likely to be causal
factors, any of these could be a contributor. It is also likely that some of the respondents are
immigrants.




                                                39
                                 Education              Frequency     Percent
                            th
                         < 9 grade                             20         14.6%
                         Some high school                      19         13.9%
                         High school graduate                  41         29.9%
                         GED                                   25         18.2%
                         Some college                          25         18.2%
                         College graduate                       6         4.4%
                         Post grad                              1         0.7%
                                             Total            137         100%


Services: need, use, difficulty of access
The existence of a targeted, alternative system of care (the Ryan White CARE Act) is readily
apparent in a review of use of medical services among homeless PLWH/A who are sheltered.
This group reports need for medical care more frequently than any other group, but also the
highest rate of use and least perception of barriers to access. The exception to this is found
among unsheltered homeless persons, as discussed previously. However, Ryan White funding
is also threatened, and basic and supportive services other than ambulatory medical care have
already been affected. The result of these funding decisions is reflected in the table that
follows.

        Service                                      Need           Use      Difficult Access
        Case management                          72.3%          70.1%                 39.3%
        Clothing                                     89.3%      80.8%                 47.4%
        Dental                                       77.8%      60.1%                 52.4%
        Emergency shelter                        55.5%          61.1%                 52.9%
        Food service                                 84.2%      71.5%                 36.1%
        Housing voucher                          78.9%          38.1%                 65.4%
        Information and referral                 70.5%          65.1%                 46.2%
        Job placement                                78.6%      58.4%                 58.8%
        Job training                             74.8%          55.7%                 53.5%
        Medical care                             73.3%          71.7%                 37.3%
        Mental health care                       59.8%          48.1%                 49.1%
        Rental assistance                        67.5%          48.5%                 60.7%
        Substance abuse treatment                50.8%          50.8%                 42.1%
        Transitional housing                     73.4%          55.3%                 55.2%
        Transportation                               77.7%      74.2%                 43.7%




                                                      40
Victims of Domestic Violence

Definition
In this category are individuals who report having been victims of domestic violence on the
appropriate survey item, or who indicate having been a client of an agency that serves this
population. Of the homeless population, 11.3% indicated a history of domestic violence; all
were female. When gender is controlled, so that only homeless women are considered, the rate
rises dramatically—to 56.3% of the 215 homeless women in the sample. In the context of the
Enumeration, 1,357 women are homeless victims of domestic violence.

Challenges
Traumatized both physically and emotionally, many caring for children and in hiding, victims of
domestic violence face challenges that are difficult to anticipate, let alone for which it is difficult
to prepare. Shame, secrecy and escalating threats can limit a woman’s ability to seek
assistance. Even though excellent programs exist, their capacity is insufficient to the need.
Unsheltered victims of domestic violence are especially vulnerable, as respondents often
reported in focus groups and interviews.
    “Í am not used to feeling helpless, to being such a victim. I have an education, I am a
    lawyer, but I spent 12 long years… too many secrets... now, look at me. My whole life
    is a secret. He tried to kill me; he would have. And he is prominent. You would be so
    surprised to know who he is. No one knows where I am. I can’t go back to work like
    this. If I leave the program, I have nowhere else to go and I can’t ever let him find me.
    The worst part about this is how completely common my story is.” — Female, 36

Housing status
In the acute stage of coping with domestic violence, many women seek out a women’s shelter.
Their success often depends on having information, transportation, accommodations for their
children, and space available in the shelter. As revealed in the table below, for more than 20%
shelters were not an accessible option.

                                          Currently staying
                                                     Frequency         Percent
                         Transitional housing                  49        42.2%
                                Shelter                        40        34.5%
                         Abandoned building                     1         0.9%
                                  Car                           2         1.7%
                                 Street                        21        18.1%
                                 Other                          3         2.6%
                                           Total              116      100.0%




                                                   41
Demographic data

   Race/Ethnicity
The proportion of White women in this group is greater than in any other sub-population, and
the proportion of African-Americans is lower. Studies show that this does not represent an
inconsistency, since domestic violence crosses all categories and strata of society. Further,
because disparities may exist among racial groups with respect to access to shelters and
transitional programs, and because some cultures consider violence to be inevitable in familial
relationships, domestic violence is often under-reported.

                               Race               Frequency          Percent
                       African-American                      57          47.5%
                       Asian/Pacific Islander                 3          2.5%
                       Native American                       7           5.8%
                       White                                32           26.7%
                       Mixed                                  8          6.7%
                       Other                                 13          10.8%
                                         Total              120          100%


With respect to ethnicity, 15% (n=18) of the 120 respondents indicated that they were Hispanic
in origin.

   Age
The average age for this group was 38, slightly younger than for women in the general sample
of homeless women (age=39). The distribution mirrors that of the sample.

                               Age range Frequency Percent
                                  < 20                  4         3.4%
                                 20-29                23      19.5%
                                 30-39                29      24.6%
                                 40-49                45      38.1%
                                 50-59                17      14.4%
                                      Total           118     100%


   Gender
All respondents in this category were female. Thirty-six women (36.4%) indicated that they had
children living with them. The chart that follows shows the number of children per woman, the
number of female-headed household and the total number of children.




                                                 42
                     Children / woman          No. of women           Total children
                            1                               15                   15
                            2                               10                   20
                            3                                8                   24
                            4                                2                    8
                            5                                1                    5
                                  TOTAL                     36                   72


   Income range
More than 88% of the group reported no income, or an annual income of less than $10,000.
The percentage for $11,000-$20,000 was 2% higher than in the sample and just under 1%
higher for income greater than $30,000.

                           Income range          Frequency            Percent
                           None                             69         57.5%
                           1,000-10,000                    38          31.7%
                           11,000-20,000                    8           6.7%
                           21,000-30,000                    2           1.7%
                           31,000-40,000                    3           2.5%
                                      Total                120          100%


   Education level
The proportion of women in this group that achieved education beyond high school was higher
in this group (24% vs. 16.4%), with the increase most apparent among those who reported
having completed “some college.”

                          Education                    Frequency Percent
                             th
                          < 9 grade                               9      7.4%
                          Some high school                       21     17.4%
                          High school graduate                   30     24.8%
                          GED                                    32     26.4%
                          Some college                           23     19.0%
                          College graduate                        4      3.3%
                          Post-grad                               2      1.7%
                                              Total          121         100%




                                                      43
Services: need, use, difficulty of access
This group was the only one that ranked job training above job placement as a service need,
and reported the need for housing vouchers and case management more frequently than did
the others. Because of the number of children accompanying these women, statistics for
childcare are also shown below.


                   Service                  Need            Use      Difficult Access
        Case management                     74.5%         60.8%                 46.4%
        Clothing                            89.2%         68.3%                 42.2%
        Dental                              84.6%         47.5%                 63.0%
        Emergency shelter                   53.4%         51.2%                 61.4%
        Food service                        74.8%         62.4%                 40.5%
        Housing voucher                     91.6%         26.1%                 72.7%
        Information and referral            81.2%         54.6%                 53.0%
        Job placement                       76.5%         38.2%                 48.4%
        Job training                        77.4%         37.6%                 55.4%
        Medical care                        73.7%         64.4%                 51.2%
        Mental health care                  55.6%         41.2%                 60.3%
        Rental assistance                   71.6%         34.1%                 71.0%
        Substance abuse treatment           49.6%         36.4%                 54.4%
        Transitional housing                67.0%         37.8%                 71.2%
        Transportation                      77.3%         57.6%                 57.0%
        Child care                          34.8%         31.6%                 58.8%




                                              44
Persons Currently Incarcerated or Released from Incarceration

Definition
Although HUD does not currently recognize those who have served time in jail or prison as a
special-needs population, clinical experience certainly justifies considering them as such. In this
study, 102 men were currently serving time in the Ramsey unit of the Texas Department of
Criminal Justice. An additional 106 men and 53 women had been incarcerated in the past five
years and were currently homeless. Those released from jail or prison represent 15% of the
homeless population. This section reviews characteristics of persons who are currently
incarcerated, and those who have been released.

Housing status
Of the 159 persons with a history of incarceration who are currently homeless, 154 reported a
specific current residence.

                                       Currently staying
                                                Frequency          Percent
                       Transitional housing               52         33.8%
                       Shelter                            51         33.1%
                       Abandoned building                  1          0.6%
                       Car                                 6          3.9%
                       Street                             41         26.6%
                       Other                               3          1.9%
                                       Total            154         100.0%


Challenges
According to research, findings from this study, and the clinical experience of providers of
services to those who are incarcerated or are releasees, persons in this group are confronted
with innumerable challenges as they attempt to readjust to life ’outside.’ Focus group
participants most often indicated that they had been incarcerated for drug-related offenses,
often felony offenses. Harris County receives more releasees than any other county in Texas.
   “You get dropped off late at night with a few bucks, maybe three days of your meds and
   an ID that’s got ‘felon’ stamped all over it. Then they tell you to go get a job, go get an
   apartment. But who is going to hire you with all that going on? There’s more of us out
   here [on the street] than anybody knows. I don’t want to be out here. I’m still sober, but
   how long is that going to last? I’m tired, real tired, and I just want a job and a place to
   stay.” — Male, age 63




                                                45
Demographic data

   Race/Ethnicity
Whites represent the largest proportion of the incarcerated than any other group, and African-
Americans the largest proportion of those who have been released. All of those who are
incarcerated had been so for longer than five years.

                                              Race
                                         Incarcerated                     Released
                                    Frequency          Percent    Frequency        Percent
        African-American                     38            38%            113        68.5%
        Asian/Pacific Islander                0               0             2           1.2%
        Native American                       5             5%              2           1.2%
        White                                43            43%             30        18.2%
        Mixed                                 5             5%              8           4.8%
        Other                                 9             9%             10           6.1%
                            Total           100            100%           165           100%


   Age range
The average age of releasees was 42—not significantly different from the sample—and for
currently incarcerated persons the average age was a much older 50. The distribution was
skewed toward older individuals, as shown below.

                                            Age Range
                                    Incarcerated                   Released
                               Frequency     Percent          Frequency     Percent
                 <20                    0              0              4         2.4%
                20-29                   0              0             13         7.9%
                30-39                  10          9.9%              34         20.7%
                40-49                  40         39.6%              83         50.6%
                50-59                  37         36.6%              27         16.5%
                60-69                  14         13.9%               3         1.8%
                    Total             101         100%              164         100%




                                                  46
   Gender
The incarcerated respondents were in a group at a men’s prison. The group of releasees
included 53 women (33.3%), a much higher representation than women in the general sample.

                                              Gender
                                    Incarcerated                 Released
                               Frequency      Percent      Frequency     Percent
                Male                  102       100%             106        66.7%
               Female                    0           0            53        33.3%
                     Total            102       100%             159        100%


   Income range
Income range is reported for releasees only. The data indicate a higher percentage with no
income (71.3% for releasees and 66.1% for the general sample). This lack of financial
resources among releasees was confirmed in focus groups and interviews.

                                Income         Frequency       Percent
                             None                        117    71.3%
                             1,000-10,000                39     23.8%
                             11,000-20,00                  3     1.8%
                             21,000-30,000                3      1.8%
                             31,000-40,000                1      0.6%
                             41,000-50,000                1      0.6%
                                      Total              164     100%


   Education level
The Texas criminal justice system served as the source of education for many of the
respondents. Focus group participants indicated that all who had completed college had done
so while incarcerated, with several also completing a GED.




                                                47
                                            Education
                                        Incarcerated                     Released
                                    Frequency          Percent      Frequency    Percent
             th
         < 9 grade                            3          3.0%              20       12.1%
         Some high school                     1          1.0%              21       12.7%
         High school                         21         21.0%              29       17.6%
         graduate
         GED                                 24         24.0%              53       32.1%
         Some college                        23         23.0%              36       21.8%
         College graduate                   28           8.0%               6       3.6%
                          Total             100                           165       100%


Services: need, use, difficulty of access
Releasees rated job placement as their third highest priority, behind clothing and transportation
(which they stated was necessary to get work). Almost half of the group had used a job
placement service and just over 60% indicated that access to such services is difficult.

                                            Releasees
                    Service                   Need                Use    Difficult Access
         Case management                     68.4%               44.1%            41.9%
         Clothing                            87.6%               64.2%            42.9%
         Dental                              79.6%               32.3%            56.3%
         Emergency shelter                   59.7%               48.7%            45.2%
         Food service                        77.5%               47.8%            32.6%
         Housing voucher                     79.9%               23.9%            71.9%
         Information and referral            72.8%               48.7%            38.6%
         Job placement                       81.3%               49.0%            61.8%
         Job training                        76.6%               29.4%            68.4%
         Medical care                        75.8%               50.3%            39.2%
         Mental health care                  43.1%               28.3%            47.6%
         Rental assistance                   65.2%               18.2%            62.5%
         Substance abuse treatment           58.1%               40.3%            26.5%
         Transitional housing                64.5%               36.3%            49.4%
         Transportation                      84.1%               51.9%            63.6%




                                                  48
Most answered, “Need.” Very few responded “N/A” to ”Use” and ”Access,” citing that these
were not applicable, but indicated to the surveyor that they did believe it was relevant and
important to report the services that they anticipated would be needed upon their release.

                                          Incarcerated
                                      Service                 Need
                           Case management                    46.5%
                           Clothing                           65.1%
                           Dental                             67.4%
                           Emergency shelter                  39.5%
                           Food service                       58.1%
                           Housing voucher                    55.8%
                           Information and referral           65.1%
                           Job placement                      73.3%
                           Job training                       55.8%
                           Medical care                       72.1%
                           Mental health care                 32.6%
                           Rental assistance                  55.3%
                           Substance abuse treatment          39.5%
                           Transitional housing               46.5%
                           Transportation                     59.3%




                                                49
Marginally housed

Definition
This group also falls outside of the classification as a special-needs population, but was
included in the study to elucidate some of the parameters associated with being at risk of
homelessness in order to assist in prevention planning. Persons were included in this category
if they indicated that they were homeless but living in the home of a family member or friend.
They were not included in computations of homeless persons. Because the number of
respondents is low (n=81), it is suggested that the data be used as the basis for future studies
or in comparison to service provider information, but not as a basis for broad generalizations.

Challenges
These are the persons who are living on the edge of homelessness, and who consider
themselves to be homeless. They are individuals who seek basic services as prevention
against living on the streets, and who are the target clients of agencies providing rental
assistance, utility payments, etc.
   “I’m staying with friends when I can, so I’m not really homeless. I’m not one of them on
   the street like you see at the Pierce. Yeah, I’ve stayed a night or so in my car and at
   the… [rooming house]. I work when I can. I got friends, I’m not homeless, not really, not
   like that.”

Housing status
These respondents were ’doubled up’ with friends or family—a practice that, according to focus
group participants, is a common method of preventing homelessness. Unfortunately, it is too
often ineffective as a longer-term strategy because of a host of psychosocial, as well as
financial, reasons.

Demographic data

   Race/Ethnicity
Twenty-five respondents reported being Hispanic (30.9%). When Hispanics who indicated
“Other” race are also counted, the rate rises to 48%. This is very consistent with interview and
focus group data, wherein respondents told numerous stories of ’doubling up,’ especially with
family if an older person, or with friends as an adolescent or young adult.

                                 Race           Frequency      Percent
                         African-American               47       58.0%
                         Native American                  5        6.2%
                         White                          11       13.6%
                         Mixed                            4        4.9%
                         Other                          14       17.3%
                                        Total           81        100%




                                                50
   Age range

                                Age            Frequency           Percent
                                < 20                      6            7.4%
                                20-29                    13            16.0%
                                30-39                    14            17.3%
                                40-49                    24            29.6%
                                50-59                    23            28.4%
                                60-69                     1            1.2%
                                  Total                  81            100%


   Gender
Consistent with the general homeless population, 80.6% of the marginally housed are male and
19.4% are female.

   Income range
Almost 93% of the respondents report income less than $10,000. While more than half of this
group reports no income, among homeless respondents that rate is 66%

                               Income             Frequency            Percent
                         None                              43           53.1%
                         1,000-10,000                      32           39.5%
                         11,000-20,000                        6          7.4%
                                       Total               81            100%


   Education level
The education level of these respondents is comparable to that of homeless respondents but,
again, because of the small sample size and number of categories, generalizations about this
information are not prudent.

                              Education                Frequency          Percent
                         th
                      < 9 grade                                   14       17.3%
                      Some high school                            20       24.7%
                      High school graduate                        23       28.4%
                      GED                                         11       13.6%
                      Some college                                12       14.8%
                      College graduate                             1           1.2%
                                          Total                   81        100%




                                                  51
Services: need, use, difficulty of access
Although the percentages of those who report given needs are lower than among homeless
persons, the pattern is virtually indistinguishable—basic needs, dental care and job placement
rise to the top here also.

                    Service                 Need            Use      Difficult Access
         Case management                    50.7%         37.5%                56.3%
         Clothing                           77.9%         68.4%                48.3%
         Dental                             79.7%         32.9%                76.6%
         Emergency shelter                  43.1%         43.9%                66.7%
         Food service                       65.3%         63.1%                48.1%
         Housing voucher                    61.1%         21.1%                83.7%
         Information and referral           59.2%         36.1%                66.7%
         Job placement                      66.7%         35.1%                71.4%
         Job training                       59.4%         26.7%                80.0%
         Medical care                       62.0%         45.2%                60.4%
         Mental health care                 47.1%         37.5%                69.8%
         Rental assistance                  51.5%         28.7%                74.2%
         Substance abuse treatment          35.3%         29.2%                50.0%
         Transitional housing               43.5%         26.4%                63.9%
         Transportation                     67.1%         39.2%                56.5%




                                              52
Families with Minor Children

Definition
For purposes of this study, respondents who indicated that they were living with children under
age 18 to whom they were related, or for whom they were guardians, were classified as
families. Most of the families included a single parent, usually female, and most were housed in
transitional housing programs. The sample included 140 family units with 345 children under
age 18.

Challenges
More than half of the families in this group indicated that they had been homeless for more than
a year, with 25% of the group reporting that they had been unable to secure housing for more
than five years. The apparent threats to the healthy development of the children in these
families are exacerbated by the duration of their homelessness. Homeless parents with co-
occurring substance abuse, mental health disorders or medical conditions find that services to
them are limited because programs cannot accommodate their children.
   “I will make it because of my kid. I don’t know how… no money… nowhere to go. The
   people here [shelter] help watch the kids so I can try to get a job. But I don’t get much
   time here, maybe two more weeks. What can I do in two more weeks. I need more time
   and more help and more money and I need a job… real bad I need a job.” — Female, 19

Housing status
Transitional housing programs are more readily available for families than for individuals, as is
reflected in the following chart. Data from both the Needs Assessment and the Enumeration
showed that a much smaller proportion of respondents in this group lived on the street. Those
who did were chronically homeless, had greater rates of mental illness and reported often that
they feared that seeking services would cause them to lose custody of their children.

                                         Currently Staying
                                                  Frequency       Percent
                        Transitional housing              82        58.6%
                               Shelter                     44       31.4%
                        Abandoned building                   3       2.1%
                                Car                          1       0.7%
                               Street                      10        7.1%
                                         Total           140        100%




                                                 53
Demographic data

   Race/Ethnicity
The pattern of race for families is consistent with that for the homeless population represented
in the entire study. The proportion of Latinos in this group, however, is more than twice that of
the larger sample—21.9% (n=30) vs. 9.9%. This finding was validated by the focus groups,
wherein participants with children also tended to be younger, more often female, and of
Hispanic origin.

                                Race             Frequency             Percent
                         African-American                       90       65.7%
                          Native American                        3        2.2%
                               White                            20       14.6%
                               Mixed                             4        2.9%
                               Other                            20       14.6%
                                       Total                137          100%


   Age
The average age of the adult respondent in a family was 36, much younger than the overall
group average of 42, with 39% indicated that they were between the ages of 30 and 39.

                             Age range         Frequency             Percent
                                <20                         2          1.5%
                               20-29                    31            22.8%
                               30-39                    53            39.0%
                               40-49                    35            25.7%
                               50-59                    14            10.3%
                               60-69                        1          0.7%
                                   Total               136             100%


   Gender
The most notable demographic finding is the difference in the rate of females between the
general homeless population and families (19% vs. 67.9%). The chart below shows the gender
of respondents, with only one member of a family included. It is interesting to note that of the
men in families who were surveyed, none was a single parent. Thus, although there were 95
women of the 140 who participated in the study, all 140 families included an adult female.

                              Gender        Frequency            Percent
                                Male                   45            32.1%
                              Female                   95            67.9%
                                 Total                140            100%


                                                 54
   Income range
The income levels for families are slightly higher than the overall group, somewhat due to
eligibility and access to public assistance to families. The rate is somewhat skewed since those
respondents who were residing in transitional housing facilities were more likely to have been
enrolled in entitlement programs. In addition, those few respondents who reported incomes for
the past year of greater than $30,000 were newly homeless due to domestic violence and
indicated that they were not likely to be able to sustain that level of income.

                          Income range          Frequency        Percent
                               None                    60         43.5%
                           1,000-10,000                59         42.8%
                          11,000-20,000                13          9.4%
                          21,000-30,000                 2          1.4%
                             >$30,000                   4          2.9%
                                    Total             138          100%


   Education Level
Approximately 13% of the families had achieved a level of education beyond high school, while
60.7% completed high school or had earned a GED. All of the 12 individuals who reported less
than 9th grade education were older than 20, and 75% were likely relatively recent immigrants.


                            Education             Frequency        Percent
                               th
                            <9 grade                        12        8.6%
                        Some high school                    25       17.9%
                       High school graduate                 45       32.1%
                               GED                          40       28.6%
                           Some college                     15       10.7%
                         College graduate                    3        2.1%
                                        Total           140          100%


Families represented in special needs populations
Throughout this report, data about special-needs populations have included both
unaccompanied individuals and those in families. The following chart delineates the proportion
of respondents in families who also fall into these groups. The dataset included 107 families.
Totals are not provided, since a respondent could fall into more than one category; for example,
a person might be chronically homeless and have a mental health disorder.




                                                55
While most rates are consistent with the general sample, a few are noteworthy. Rates for
domestic violence underscore the threat of homelessness for women subjected to that
condition. Rates of HIV among family respondents show that it is not only the seropositive who
is at risk of homelessness. That more than one-third of families are chronically homeless
suggests that despite the greater availability of many services to persons in families, a vast
unmet need remains.

                             Population                Frequency      Percent
                       Chronically homeless                    35         35%
                            Mental health                      60       56.1%
                          Substance abuse                      62       57.9%
                         Domestic violence                     54       50.5%
                              Veterans                         21       19.8%
                              HIV/AIDS                         26       24.5%
                        Prison/Jail releasee                     8       7.5%


Services: need, use, difficulty of access
Compared to the general sample, families report higher needs for dental care, childcare and job
placement. Use of these services, as well as transitional housing and medical care, is also
higher. Perceptions of difficulty in gaining access to services is quite consistent with the general
sample.

                       Service                 Need        Use       Difficult Access
                 Case management               70.0%      58.8%                 41.1%
                      Child care               53.6%      52.0%                 56.3%
                       Clothing                85.6%      69.8%                 47.7%
                        Dental                 81.4%      51.5%                 54.3%
                 Emergency shelter             46.9%      46.5%                 52.5%
                    Food service               67.3%      63.8%                 36.8%
                  Housing voucher              79.2%      31.7%                 66.7%
               Information and referral        71.0%      49.5%                 50.8%
                   Job placement               78.0%      46.6%                 56.5%
                     Job training              69.0%      42.1%                 57.1%
                    Medical care               59.4%      54.5%                 46.4%
                 Mental health care            41.2%      33.0%                 61.5%
                  Rental assistance            64.0%      42.5%                 71.7%
             Substance abuse treatment         40.8%      33.6%                 50.0%
                 Transitional housing          58.2%      44.6%                 61.8%
                    Transportation             71.0%      55.3%                 42.9%




                                                56
Youth

Definition
To be included in this category, respondents indicated that they were between the ages of 16
and 25, were not living with older relatives or guardians, and were currently homeless. Eighty-
seven persons met these criteria. Of these, 29.2% were also parents.

Challenges
It is clear from research in other communities, as well as from the current study, that
determining an accurate prevalence of youth who are homeless is quite difficult; young persons
often are inaccessible to service providers and do not consider themselves to be homeless,
although they have neither a secure residence nor a consistent means of support. Despite the
paucity of data, it is known that youth who have been in foster care often become homeless
when they reach 18 and ’age out’ of that system of care. A similar situation exists when a
young person is released from incarceration in either the juvenile or adult criminal justice
system. According to young women in focus groups, several became homeless when their
families ousted them for becoming pregnant. Few services exist for this group.
   “I been homeless since I was 11. Got put out, got made homeless. And you can’t fend
   for yourself. It’s stuff you can’t even do until you eighteen. So, basically you out there
   on your own and you doing stuff illegally and you doing stuff just to take care of yourself.
   You know, you have no choice.” — Male, age 17

Housing status
The profile of sheltered to unsheltered youth shown in the following table does not truly
represent the actual rates. Rather, it reflects the young persons whom the researchers were
able to reach for inclusion in the study. Data from the focus groups suggest that the number of
homeless youth who are unsheltered far exceeds those who are sheltered.

                                        Currently Staying
                                                 Frequency        Percent
                       Transitional housing               22        25.6%
                              Shelter                     31        36.0%
                        Abandoned building                  2        2.3%
                               Street                     31        36.0%
                                        Total                       100%


Demographic data

   Race/Ethnicity
The proportion of African-American youth is slightly higher than that for White youth, as shown
below. Of note also is that in comparison to other sub-populations, youth identify as “mixed”
race with greater frequency.




                                                57
                               Race                 Frequency            Percent
                         African-American                        30          35.3
                       Asian/Pacific Islander                     1             1.2
                         Native American                          5             5.9
                               White                             25          29.4
                               Mixed                             13          15.3
                               Other                             11          12.9
                                          Total                  85        100%


   Age
Most of the youth who participated in the survey were between 20 and 25 years of age. The
younger respondents were not living with their parents or older relatives.

                            Age range         Frequency           Percent
                                <20                     20             23%
                               20-25                    67             77%
                                  Total                 87            100%


   Gender
Youth comprise the only sub-population where the rates of males and females are almost equal.
Additional research is suggested to determine the duration and reasons for this phenomenon.

                                Gender Frequency Percent
                                 Male                  48        57.8%
                                Female                 35        42.2%
                                   Total               83        100%


   Income range
Compared to the adult homeless population, youth have fewer financial resources. The sources
of income they report include public assistance, including Social Security Disability income, for
which they or their children are eligible.

                          Income range            Frequency           Percent
                               None                         64         74.4%
                           1,000-10,000                     17         19.8%
                          11,000-20,000                      2           2.3%
                          21,000-30,000                      3           3.5%
                                      Total                 86          100%



                                                  58
   Education level
Forty percent of this group completed high school or a GED program. Since only five of the
respondents were younger than 18 and may still be in school, it can be assumed that of the 43
who indicated that they had not completed high school, 38 had dropped out.

                             Education               Frequency    Percent
                                   th
                              <9 grade                      10      11.6%
                          Some high school                  33      38.4%
                        High school graduate                23      26.7%
                                   GED                      12      14.0%
                            Some college                     7       8.1%
                          College graduate                   1       1.2%
                                          Total             86      100%


   Services: need, use, difficulty of access
For youth, access to job training and job placement rival basic services as their most frequently
cited needs. In contrast, job placement and training services are reported to be the most
challenging to acquire, well beyond any services other than housing vouchers.

                        Service                   Need      Use    Difficult Access
                 Case management                  10.0%   34.2%               55.3%
                        Clothing                  73.8%   57.8%               52.5%
                        Dental                    69.5%   41.5%               53.5%
                 Emergency shelter                41.8%   39.5%               55,6%
                     Food service                 71.4%   42.0%               51.1%
                  Housing voucher                 64.6%   19.6%               71.4%
               Information and referral           57.8%   35.4%               66.7%
                     Job placement                72.8%   31.7%               83.8%
                      Job training                74.7%   32.9%               74.4%
                     Medical care                 63.0%   51.2%               51.1%
                 Mental health care               39.5%   35.3%               62.2%
                  Rental assistance               58.8%   23.2%               66,7%
            Substance abuse treatment             44.4%   31.7%               48.6%
                Transitional housing              51.2%   27.7%               62.9%
                     Transportation               78.6%   41.0%               52.8%




                                                   59
                                               CONCLUSIONS

Factors That Can Lead to Homelessness
The intrinsic factors most associated with becoming homeless and remaining homeless are:
   1. Lack of source of income
   2. Substance abuse
   3. Disability or illness
   4. Mental illness
   5. Domestic violence
   6. Incarceration
Poverty causes homelessness. Each of these conditions can lead to poverty which, for
purposes of this study, can be divided into generational and situational poverty. Generational
poverty is a long-standing legacy of indigence that can limit a people’s access to education,
health care, adequate and safe housing, and other resources that enable the at-risk person to
become sufficiently self-supporting. Situational poverty is the state whereby a person, because
of choices or circumstances, becomes incapable of being self-supporting. Items in the
preceding list can cause situational poverty, but are also often associated with generational
poverty. Obviously not all people struggling with these conditions become homeless, but lack of
income combined with a lack of familial, social or community support almost guarantees
homelessness.
The study questioned homeless persons with respect to their opinions about the causes of
homelessness. The chart that follows illustrates their responses.


                                     Reasons for homelessness

                     44




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                                                      60
The respondents ranked the lack of a job as the most common reason for persons becoming
homeless. The concept of “Choice” is a bit more complex. Within this category, respondents
offered several explanations that put the responsibility for their situation on themselves. Typical
comments:
   “Nobody made me start taking drugs and now I can’t get off. So I am here.”
   “I don’t want to be on the streets, but there is no way I’m going into one of those
   shelters. You aren’t even feel human there. I can’t do that again.”
   “It’s real bad out here and I’m sick. But these people around here [in the encampment], I
   know them and they got my back. You don’t know what can happen in them shelters.”
   “When I got divorced, I just walked out and left her everything. My choice. I was too
   much for her and I knew it. So here I am 12 years later, no house, no job and still
   drinking.”
That substance abuse can lead to loss of resources, and thus homelessness, is hardly a
revelation—the image of the man on ’skid row’ is a cultural archetype. Repeatedly, however,
during focus groups and in street interviews, respondents spoke poignantly about the particular
devastation caused by addiction to crack cocaine. There was a 75% overlap between people
with mental health disorders and substance abuse in this survey, begging the question about
the role of self-medication in substance abuse. Further, volumes of data from studies
questioning the role of physical and sexual abuse in women’s mental health consistently cite the
correlations between abuse and addictions in women.
   “You don’t know how depressed I was. I didn’t care and I wanted to die and I started
   getting high. It was great and I wanted to keep that and I did. What did I have to lose?”
   “I’ve been on the streets since I was 12 and I’m 40 now. I would’ve run away to get
   away from the abuse, but I didn’t have to. I came home one day and they were gone.
   My mother and that [expletive] who was with her, both gone. Never saw them again.
   For most of the time since, ‘til now, ‘til I came here, I was high. And it’s real sad. I mean
   I was a kid then and got abandoned by my own mom. My own mom and I was a real
   baby once.”
Severe, untreated mental health disorders, with or without co-occurring substance abuse, can
leave a person utterly incapable of managing the exigencies of a job, running a household or
simply managing the activities of daily living. For respondents to this study, mental illness was
considered a major disabling condition, even more common among them than physical
disability.
Nonetheless, there is a myth among the general public that mental health disorders are all
treatable and containable and that people struggling with mental illness, especially if homeless,
are recalcitrant or malingering. In a focus group for families who are direct or indirect caretakers
of mentally ill family, these myths were dispelled.
   “First, you gotta figure out that something is really wrong with your son, not just that he’s
   a delinquent or something. Then you gotta find someone to help him and you gotta be
   able to pay for whatever treatment they come up with.”
   “Every day I live in terror of what will happen to her when we die. I wonder how she will
   be safe. Have you tried to find housing for someone like her [schizophrenic]? It’s
   impossible. Please tell people in your report not to forget our children. They don’t want
   the lives they have—they did nothing to become like this. But I wonder so often what I
   could have done. Could I have prevented this?”


                                                61
Complicating the ability to cope with and treat mental illness or physical disability is the cost
associated with care. As reported here, 11% of the sample lost their last stable residence
because of disability. The study also shows that self-reported medical conditions among people
who are homeless are truly under-reported, mainly because disparities in access to medical
care lead to a lack of diagnosis and treatment.
Further, local studies have shown that more than 800,000 persons in Harris County are
uninsured. This, in the county that houses the largest medical center in the world.
   “You hear people say that we don’t want to work. Not true. I was injured at my last job
   and lost my job because of that. Now I have pain all the time and I can’t work. I should
   have another operation. Yeah, right”
   “I’ll tell you what happens when your wife gets sick and you lose everything trying to get
   her help. She dies and you end up on the street with nothing.”
The “Situation” category encompassed domestic violence, incarceration and more vague
notions, such as “life is just hard” or “it’s just the way it is.” The quotes included in the profiles
elucidated the barriers encountered by women who are victims of domestic violence. Though a
well-developed system of care is in place for women who have experienced domestic violence,
that system remains overburdened.
   “I am in this program and this is the only place I feel safe in. I’ll make it for my kids and
   because I deserve better. You see over there? She’s my daughter and that baby is my
   grandbaby. My little girl is only 16 and the baby is two. All here. She got me to come
   here after she had to get away from the baby’s father and told me to get away, too. We
   are safe, now.”
   “I have been a provider for more than 10 years and the women who come here now are
   younger and the problems they have are more severe than ever. Some have addictions,
   there are language barriers, and they are so young. And it’s getting harder to get
   funding for our programs. The need is not going away, just the resources.”
For persons who have been incarcerated, reintegration can be a path that cannot be walked.
Services within prisons have been cut with funding reductions and a system of aftercare to
releasees is still in development and in many ways untested.
   “I’ve been in and out of prison from the time I was a kid, but this is the first time I have
   been in a program. Maybe this will help. They care about us here and they don’t let us
   get away with nothing. But that’s good. I need a job more than anything.”
   “You can understand with employers that they don’t want to hire any of us. Hey, I did my
   time and I’m not going back—not ever going back. But I gotta work and I can work.
   How many other employees got a parole officer looking over their shoulder at everything
   they do?”
Whether considering a sub-population or homeless persons as a group, the system of care is
over-burdened, under-staffed and under-funded. Options for shelter are limited, and for
permanent housing egregiously so. Service provision is often required to be based on
exigencies of available funding rather than best practices and, most important, providers are
asked to measure success in outcomes that are irrelevant to the realities of their clients lives.




                                                  62
A Model to Serve Persons Who Are Homelessness
To truly reduce or end homelessness requires a multi-stage approach with refinements within
the current continuum of care. The steps involve:
    1. Defining the problem to be solved
    2. Realistic program planning for clients
    3. Support for variable systems of care
    4. Implementing evidence-based practice
    5. Developing standards of care
    6. On-going assessment of the system

Defining the problem to be solved
Creating awareness in the community-at-large about the realities of homelessness is a critical
first step in addressing the problem. Public information campaigns rising above the stereotypes
that exploit or vilify homeless persons can be developed out of the data from this study and the
experience of service providers. It is equally important that the community realize that a goal of
permanent housing for all persons, regardless of their drug use, mental status or history of
incarceration, is the core assumption if homelessness is to be eliminated. Further, advocates
and providers must assist program funders in understanding that there are homeless persons
for whom a return to work is an impossibility, and that for some clients lifelong involvement with
the system of care is a success.

Realistic program planning for clients
Providers of services to homeless persons have long reported that most of their resources are
spent on people who are chronically homeless and that the outcomes expected for these
clients—re-employment and consistent housing—are virtually impossible to achieve within the
current system of care. Further, there are clients who are episodically homeless, vacillating
between relative stability and crisis. Serving these groups leaves few resources for prevention
or assessment of outcomes, and for caring for those who are newly, temporarily homeless.
Based on the findings of this study, on the experience of providers and on the professional
literature, it is apparent that the system of care could be more effective if it truly acknowledged
and accommodated the variations in need and resources that clients present. It is important to
note that in the proposed model it is not expected that clients course through the categories.
Rather, with effective assessment, it becomes clear which system of care can best benefit them.
Regardless of the sub-population that clients represent, they can be grouped into three main
categories based on the level of interface with systems of service that they require:
         Extensive care
         Ongoing assistance
         Temporary assistance




                                                63
   Extensive care
This group is composed of individuals who are seriously compromised by severe mental illness,
intractable substance abuse or mental retardation. Most are chronically homeless and are
those clients who, in the past, were typically institutionalized. Based on this study and the
experience of providers, it is estimated that this group makes up about 35% (n=4,200) of the
homeless population. Services to this group must be lifelong and highly structured, with clients
closely monitored. The goal for these clients is that they are assisted in sustaining safe, secure
housing within a system of care. Clients in this group are those served by ‘Safe Haven’
programs, such as that administered by MHMRA.

   On-going assistance
For this group, contact with a system of care will be for variable lengths of time at different
intervals, but it will likely be long-term, if not lifelong. These are persons with mental illness or
substance abuse histories who are willing to participate, and capable of participating in
treatment and who, if afforded supportive services related to employment and/or housing, can
maintain both. They may be able to leave the components of the system of care for a period of
time, but will remain more stable if at least case management is maintained. It is estimated that
this group represents about 55% (n=6,600) of the population. Clients of the DeGeorge program
administered by the VA, fall into this category.

   Temporary assistance
People in this group have most often become homeless because of short-term financial crises—
loss of job, for example—but have the capacity to marshal sufficient resources and, with
assistance, can re-establish their financial viability within about 12-18 months. They comprise
about 10% (n=1,200) of homeless persons, and are served by programs such as the Zip Code
Ministries (ZCAM) that provide rental assistance, utility payments and basic needs in the short
term.

Support for variable systems of care
A model for ending homelessness must: 1) assess and strengthen the infrastructure; 2) provide
for interventions for at-risk persons; and 3) provide the appropriate level of care for those who
are already homeless. The graphic below illustrates the model and includes an explanation of
each component (see page 67).
The model assumes that a client can progress, through a system of care appropriate to his or
her resources and needs, to permanent housing. The first stage is the Point of Entry. Within
this category are those services wherein clients are introduced into the system of care.
Examples of points of entry are church programs that serve the indigent outreach programs,
targeted both to those who are homeless as well as those at risk for homelessness. Regardless
of the venue for entry into the system, the primary goal is immediate housing or shelter. Sites
include emergency shelters, transitional programs or ’housing first’ facilities, which are
subsidized rooms or apartments that include case management, but do not require that clients
be participants in a formal treatment or intervention program.




                                                 64
Once housed, persons are provided with a ’support packet’ that includes Medicaid or Gold Card
(Harris County Hospital District service card) as eligibility dictates, an identification card if
needed, a long-term bus pass for use in the local transit system, and whatever other service
eligibility documentation is necessary. When stabilized and willing, the client is then assessed
with both a standardized instrument that conforms to the fields in the HMIS (Homeless
Management Information System) and specialized assessments related to service needs.
At this point, the client can be referred to the service structure that is most appropriate. As with
any such model, this one seems to suggest an elegant and orderly process; however, that is
rarely seen in the real-life provision of services. More likely, clients will be identified and, if the
housing resource base is expanded, will be housed and followed with case management.
Depending on the client’s motivation and resources, he or she may manage to stay housed.
The measure of an effective continuum of care is the degree to which client resources and
competencies are enhanced or supported at a level that enables clients to obtain, maintain and
sustain permanent, safe and secure housing.

Implementing evidence-based practices
No matter how well defined a model for service provision might be, it is nothing more than a
possible guide. What changes the lives of homeless persons is amelioration of poverty and the
concomitant circumstances that lead to it. That occurs only if a person can gather sufficient
personal, financial and relational resources. The role of the service system is to assist the client
in gathering those resources.
Throughout the study, homeless persons reiterated that the most critical element in their ability
to gain access to and effectively use services was the quality of the relationship that they were
able to form with providers. That is the art and humanity of service provision. The science of
service provision involves strategic planning, resource monitoring and implementation of
practices that have been documented as successful with a given population, and in a given
context. Too often, providers are forced to plan services based on what might get funded,
which may or may not fit their core competencies or the needs of clients. A potentially more
efficacious strategy involves:
     1. Developing programs based on
            a. A theory of behavior or population change
            b. Agency experience
            c. Documented client need
            d. Client satisfaction
            e. Employee competence and satisfaction
     2. Enhancing staff capacity to implement the programs
     3. Defining and monitoring outcomes that identify success
     4. Developing and adhering to a business plan that assures sustainability of the agency




                                                  65
Developing standards of care
To assure a level of care across agencies, a collaboration of service providers under the
direction of the Coalition for the Homeless can create standards of care for all the major
services, shelter and housing programs that serve homeless persons. The degree to which
agencies within the Continuum of Care are invited or required to adhere to the standards will be
the decision of providers and funders.

On-going assessment
Once standards are accepted, the community of providers can undertake outcome assessment
to document the effectiveness of their services and enhance program planning. Evaluation can
be conducted with minimal burden to providers by working with the data in HMIS and collecting
and analyzing data submitted in the context of the annual response to the HUD Continuum of
Care grant.




                                               66
                                          Permanent housing



                                            Ongoing Care
                                          Variable
                                          Supportive housing
Extensive Care                            Supported work options               Temporary Services
Lifelong                                  Goal: secure housing and                Back home
Highly structured                         work, within system of care             Back to work
Closely monitored                                                                 Affordable housing
Goal: safe, secure                                                                Goal: out of system
housing, continuation
within system of care
                                                Referral
                                      to appropriate system of care


                                          Client Assessment
                                     Specialized
                                     Standardized


                                             Initial options
                        ’Housing first’ facility
                        Shelter
                        Transitional, other continuum of care program
                        Support packet: Medicaid, bus passes, ID cards, etc.


                                            Points of entry
                                     Shelters
                                     Meal services
                                     Drop-in centers
                                     Health care (includes mental health)
                                     Day labor sites
                                     Outreach
                                     Justice system
                                     Churches

                                                   67
                                        RECOMMENDATIONS

Public Policy and Planning
   1. Clearly define the role of the Blue Ribbon Commission as a body to create and monitor public
      policy related to homelessness
   2. Collaborate with the Mayor’s Houston Hope project to assure that neighborhood redevelopment
      includes housing options for individuals in each of the three client categories
   3. Participate in the annual Community Advisory Committee of the City of Houston Department of
      Housing and Community Development to assure that the consolidated plan includes funding for
      homeless services
   4. Conduct annual strategic planning conferences through the Blue Ribbon Commission and
      Coalition for the Homeless to better coordinate activities related to the Plan to End Chronic
      Homelessness and the other activities developed by the Blue Ribbon Commission
   5. Increase the availability and accessibility of substance abuse treatment and mental health care
   6. Convene a collaboration of providers of homeless services, mental health care, substance abuse
      treatment and criminal justice to develop a coordinated plan to assist those released from jail or
      prison in securing and maintaining housing and employment
   7. Support Therapeutic Drug Court
   8. Create and support Mental Health Court

Funding
   1. Identify sources of mainstream and alternative funding for housing and supportive services
   2. Inform potential funding sources about opportunities for investment within the Continuum of Care
   3. Involve funders in implementing standards of care

Increasing Access to Housing
   1. Actively engage the faith-based community, especially those with long histories of social service
      provision, such as Catholic Charities and the Episcopal Diocese to develop and maintain
      permanent supportive housing, especially for persons with mental illness or substance abuse
   2. Create ’housing first’ facilities

Service Delivery
   1. Implement the intervention model discussed in this plan
   2. Build capacity among current and potential providers to develop and maintain permanent
      supportive housing options
   3. Assure that all clients are registered for all mainstream resources for which they are eligible
   4. Implement more frequently concerted efforts to provide options for the chronically homeless
      similar to the recent “Pierce Elevated Project”
   5. Improve wage and benefit packages for providers of services to the homeless




                                                   68
                                                 References
i
 Consolidated Plan and Fair Housing data from Survey 1 are available through the City of Houston Department of
Housing and Community Development and through the University of Houston, Graduate School of Social Work,
Office of Community Projects.
ii
     Healthcare for the Homeless–Houston, 2004 Needs Assessment




                                                      69
                  SHELTER AND HOUSING CAPACITY BASED ON 2005 DATA



                                               Sheltered
                                                                         Un-sheltered   Total
                                    Emergency       Transitional
1. Homeless individuals                  1,769             1,448            5,792       9,009

2. Homeless families w/children          226               495               258         969

3. Persons in homeless families          658               1,547             791        2,996

       TOTAL (LINES 1+3)                 2,427             2,995            6,583       12,005




                                  Permanent Housing
               1. Homeless individuals                             930

               2. Homeless families w/children                     201

               3. Persons in homeless families                     543

                     TOTAL (LINES 1+3)                           1,473




                                            -1-
           GAP ANALYSIS BASED ON 2005 DATA




                Family   Family   Individual
                                               Total     %
                 Units    Beds      Beds

Emergency
                  78      236       3,185      3,421   36.2%
 shelter

Transitional
                 185      555       2,607      3,161   33.5%
  Housing

Permanent
                 276      830       2,027      2,857   30.3%
 Housing

  TOTAL          539     1,621      7,819      9,439   100.0%




                          -2-
                                                                                  Observations from the Pierce
                                                                                                             1




                            Observations from the Pierce
                —a content analysis of a Rapid Rehousing Intervention—
                                                August, 2005



Introduction

In March, 2005, a team of outreach workers and case managers, under the direction of
the Coalition for the Homeless of Houston/Harris County and the Blue Ribbon
Commission to End Chronic Homelessness participated in an intervention that offered
housing options to homeless persons who lived under the overpass on Pierce Street in
downtown Houston. One hundred and seventy-eight persons (178) chose to be
relocated to service programs, motels, back with their families or to other cities. The
number of persons who chose each option and their status at 90 days following the
intervention is available from the Coalition.

This report is a content analysis of the intake surveys completed by the case managers
assigned to the participants in the program.1 Clients’ responses to the following
questions were elicited by case managers:

    1.   Why did you choose to stay at the Pierce?
    2.   Why do you think that people are leaving the Pierce St area?
    3.   Why did you choose to stay at the …? (site where person decided to be housed)
    4.   How did you become homeless?
    5.   What services would be helpful to you?

In addition, the report includes observations of the client by case managers and a
record of any referrals that they suggested to the client.

Funding for the Pierce project was provided by:
   • CHRISTUS St. Joseph Hospital
   • City of Houston Department of Housing and Community Development
   • diPortanova Family Foundation
   • Downtown Management District
   • Houston Downtown Alliance
   • Houston Endowment
   • Metropolitan Transit Authority
   • Midtown Management District
   • Rockwell Fund
   • United Way of the Texas Gulf Coast


1
  Follow up surveys were provided to the case managers, but compliance among programs in completing them was
inconsistent and thus, a valid data set is not available
                                                                 Observations from the Pierce
                                                                                            2



Methods

Client responses to the survey were aggregated, analyzed for consistent and divergent
themes and summarized to determine applications to service delivery.

Service Sites

As shown in the following table, case managers reported on 12 sites that were available
to clients. Of these 5 were treatment and supportive services providers and 7 were
commercial residences. Data is available for 155 clients who chose these options. A
total of 108 individuals chose to reside in a hotel and 47 in service agencies.

                     Site                  Type          Number      Percent
                Budget Lodge               Motel                30         19.4
                  Cullen Inn               Motel                 8          5.2
                 Green Chase               Motel                 9          5.8
                 Greenspoint               Motel                 1          0.6
                 Ramada Inn                Motel                32         20.6
                Red Carpet Inn             Motel                10          6.5
                  Stallion Inn             Motel                 9          5.8
                            TOTAL Motel                       108       69.7%
            Lieutenant’s House        Service agency             3          1.9
             Midtown—US Vets          Service agency            32         20.6
           Path to Independence       Service agency             3          1.9
            Resurrection House        Service agency             6          3.9
                Texas Memorial        Service agency            12          7.7
                     TOTAL Service Agency                       47      30.3%
                                                                      Observations from the Pierce
                                                                                                 3


Client Responses

                  Question 1: Why did you choose to stay at the Pierce?

Of the 178 clients, 92 offered their reasons for residing under the Pierce. A sense of
desperation was the most commonly cited reason, followed closely by access to
services. The respondents tended to be chronically homeless persons, predominately
male, who expressed a sense of hopelessness, despair and a belief that they had no
other options. The following table illustrates the themes within the responses, defines
them and provides quotes as examples of each.

     Theme                         Definition                            Example
                  •   Desire to be located in close proximity
                                                                 “It is centrally located to
   Access to          to homeless service agencies,
                                                                 labor halls, services,
    services          especially those that provide for basic
                                                                 medical care, food, etc.”
                      needs.
                  •   Perception that those who resided
                                                                 “Felt comfortable being
                      under the Pierce were similar to the
                                                                 around people like me.
    Affiliation       respondent and that he or she would
                                                                 I didn’t want to be
                      find companionship with those
                                                                 alone.”
                      persons.
                  •   Respondent reported the choice was
    Agency-           grounded in the need to be in service      “I want to be around St.
    specific          range of one or more agencies that         John’s”
                      were specifically named.
                  •   Without specifying a service agency
                                                                 “People to be around
  Basic needs         respondent reported that food,
                                                                 and lots of food and
      met             minimal shelter and transportation
                                                                 clothing.”
                      would be accessible at the Pierce site.
                  •   Feelings that one is in dire
                                                                 “Couldn’t find anyplace
                      circumstances with no options than to
  Desperation                                                    else to stay. Shelters
                      stay under the overpass on Pierce
                                                                 shut down.”
                      Street.
                  •   Respondents could not articulate that
                      they had chosen to stay under the
    Passivity                                                    “Feet told me to stop.”
                      Pierce; rather, they indicated that they
                      merely drifted into the area.
                  •   Selection of Pierce St based on
     Safety           perception that it offered safety OR       “Only safe place
    concerns          that previous conditions or                available for a female”
                      encampment were unsafe.
                  •   An eclectic group of responses that
      Other           ranged from the unintelligible to those    “I be at Pierce.”
                      that were unique to the respondent.
                                                                       Observations from the Pierce
                                                                                                  4


The following graph shows the frequency as percentages of each of the themes among
the responses. These categories are non-duplicative, that is each respondent offered
only 1 reason for his/her choice.


                                   Choice to Stay at Pierce

                                                 26.4%
    23.6%




                                       11.8%
              10.0%                                           10.0%    10.9%


                                                                                     4.5%
                            2.7%


    Access   Affiliation   Agency      Basic   Desperation Passivity   Safety        Other
                                       needs
                                                                      Observations from the Pierce
                                                                                                 5


        Question 2: Why do you think that people are leaving the Pierce area?

There was little doubt among the respondents that people were leaving the Pierce area
because they were being forced to do so, however, not by the Coalition or the outreach
teams. They attributed the relocation to several sources, including Metro, local
residents or a vague reference to “the City.” However, almost 20% of the respondents
assigned the reason for the change to the Pierce inhabitants, suggesting that the
compromises they face somehow initiated the action. These responses generated far
more emotional content than any other questions, as noted in the chart below.

      Theme                         Definition                            Example
                   •   Assumption that leaving the Pierce
     Access to         and participating in the program would      “Access services
      services         give respondents access to homeless         better.”
                       service agencies.
                   •   Perception that people would be best
                       served by participating in the program
                                                                   “Everyone act like a
     Affiliation       because they would maintain contact
                                                                   family.”
                       with people whom they already knew
                       or who were homelessness.
                   •   Included notions that participating in      “Homeless programs
                       the program would allow respondents         offered to get us off
    Betterment         to improve their current quality of life.   the street, offer
                       They tended to be very optimistic in        services and make
                       tone.                                       our lives better.”
                   •   Items in this category focused on the
                       idea that the challenges that the
                                                                   “Not doing the right
                       Pierce residents face, forced named
  Compromised                                                      thing and making
                       or unnamed authorities to relocate
                                                                   unwise choices.”
                       them. The responses ranged in
                       context from guilty to angry.
                   •   Similar to the “compromise” theme,
                       these responses suggested that              “Midtown wants us
      Forced           people were leaving because they had        out and Metro wants
                       no choice and that others were              their parking lot.”
                       compelling them to do so.
                   •   These respondents determined that
                       people were leaving the Pierce for
                       very practical reasons—ranging from         “Because of cold
    Pragmatic
                       the assumption that food and shelter        weather.”
                       would be available to them or that
                       there was no reason not to leave.
                   •   Respondents noted that leaving the
      Safety
                       Pierce would allow them to live in          “Safety in numbers.”
     concerns
                       safer conditions.
                                                                               Observations from the Pierce
                                                                                                          6



The frequencies of the themes found in the participant responses are shown in the
following graph. The representation underscores the degree to which the notion of
being “forced out” was expressed by the participants. Sixty clients responded to this
question.




                                    Reasons People Left
                                                      40.6%




                                         17.2%                                             17.2%
                            10.9%
                                                                   6.3%        4.7%
             3.1%
                            t
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                                                                    Observations from the Pierce
                                                                                               7



   Question 3: Why did you choose to stay at the …? (Site where person decided to be
   housed)

Responses to this question generated the most frequent expressions of optimism and
preference. More than 23% of the participants voiced a clear preference for the type of
place to which they wanted to be relocated and an additional 9% indicated that
participation would allow them to better their lives.

This is particularly compelling in light of previous responses that were fraught with a
sense of loss of control, desperation or passivity. Once confronted with the reality that
they would be able to an extent to self-direct this relocation, many participants did so.


      Theme                        Definition                           Example
                   •   Choice of site was predicated on          “I can get help with
     Access to
                       being able to receive homelessness-       drugs and other
      services
                       related services.                         problems.”
                   •   As above, the choice of site included
                       notions that participating in the         “I want to get my life
    Betterment
                       program would allow respondents to        together.”
                       improve their current quality of life.
                   •   These respondents expressed a belief
                       that they had no other options but to
                       participate in the program. In contrast   “Where else could I
    Desperation
                       to those for whom “betterment” was a      go?”
                       motivation, their self-prognosis was
                       pessimistic,
                   •   Respondents chose their location
                       based on the premise that it was close    “Trying to find a job,
   Employment-
                       to their place of employment or that      so I won’t have to go
     related
                       they might gain employment by             back on the streets.”
                       participating.
                   •   Included in this category are
                       responses that indicate that
                       participants were not given any           “I did not choose they
     No choice
                       choice, but were placed in a residence    put me here.”
                       based on the preferences of the
                       outreach worker.
                   •   Location was based on client
                       perceptions that the choice would
                                                                 “Roof for bad weather
                       resolve a practical consideration such
     Pragmatic                                                   and people came by
                       as relief from harsh weather, access
                                                                 with food.”
                       to basic needs or simply that no other
                       option appeared to be any better.
                                                                    Observations from the Pierce
                                                                                               8


                  •   Respondents actively sought a              “Far from downtown,
                      particular location or type of location    to help fight
    Preference        and expressed partiality based on          temptation of being in
                      geographic area, feelings of comfort       crowd and to get to a
                      and relief or general environs.            better environment.”
                                                                 “I am a veteran, I
                  •   Choice of site was based on the fact
                                                                 would like help to
      Veteran         that the respondent was a Veteran
                                                                 gain stability, I need
                      who was eligible for VA services.
                                                                 the veteran benefits.”
                  •   An eclectic group of responses that
                      ranged from the unintelligible to those    “No particular
       Other
                      that were unique to the individual         reason.”
                      respondent.


The frequencies of the several categories of answers that participants offered about the
reasons for their choice of site are offered below. Almost half of the non-duplicative
responses related to improved quality of life (Betterment, Employment, Preference,
Services and Veteran). The inclusion of the relatively neutral category, “Pragmatic”
brings that rate to greater than 70%. Data from 92 respondents is included in the graph.



                                     Choice of Site



                                                        23.9%   23.9%




                  12.0%
                                              10.9%
                                                                                     9.8%
                                     6.5%
                                                                          5.4%
          4.3%             4.3%
               n




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                                              Percent
                                                                       Observations from the Pierce
                                                                                                  9


                        Question 4: How did you become homeless?

To this inquiry, respondents offered their attribution for why they became homeless and
also why they have been unable to re-establish a secure residence. The themes are
discrete categories and reflect the major reasons reported by the respondents.


      Theme                           Definition                            Example
                    •    Medical condition or specific disability
                                                                     “Got hurt on the job,
     Disability          that impaired the respondent’s ability
                                                                     now money ran out.”
                         to work or secure housing.
                    •    Distinct from the more general
     Domestic            category “family problems,” it includes     “Domestic violence
     violence            both persons who inflicted the              situation in 2004.”
                         violence or who were victims of it.
                                                                     “Lost too many jobs,
                    •    Loss of employment and the financial
   Employment                                                        lost too much money,
                         disruption that resulted from it.
                                                                     high cost of homes.”
                    •    Includes young persons who were             “Came to help
                         runaways, as well as adults who were        daughter with
      Family
                         left homeless because of divorce or         children—it didn’t
     problems
                         family discord. Does not include            work out. I’m here
                         domestic violence.                          now.”
                    •    Non-specific category that includes
                         responses that report that a person         “Mother kicked me
    Forced out
                         left housing against his or her will, but   out.”
                         does not indicate why that occurred.
                    •    Specifically links homelessness to a
                                                                     “After getting out of
                         recent release from, or a history of
   Incarceration                                                     jail in 2004, I had
                         incarceration that prevents the
                                                                     nowhere else to go.”
                         respondent from securing housing.
                    •    Mental illness or substance abuse           “Just crazy. Too
   Mental heath
                         that is so serious that it impairs the      many times, crazy.”
                         respondent’s ability to obtain,
    Substance
                         maintain or sustain safe, secure            “Due to drugs.”
      abuse
                         housing.
                    •    An eclectic group of responses that
                         ranged from the unintelligible to those     “Got rolled at bus
       Other
                         that were unique to the individual          station.”
                         respondent.
                                                                                                    Observations from the Pierce
                                                                                                                              10



Consistent with the findings of the 2005 Community Profile, the most frequently cited
reason for a person becoming homeless is loss of employment (44.8%). In the current
data, high rates of persons cite family problems (19%) and incarceration (12.1%) as the
causes of their homelessness. The following graph illustrates the findings from the
responses from 101 clients.




                                          Reasons for Homelessnes

                                                                              44.8%




                                     19.0%

                                                                 12.1%
                       6.9%                       6.0%                                       4.3%                    5.2%
           0.9%                                                                                           0.9%


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                                                                 Percent
                                                                   Observations from the Pierce
                                                                                             11



                  Question 5: What services would be helpful to you?

Among the participants only 94 identified services that might be helpful to them. That
they are chronically homeless is evident in their request for the most basic services,
finding which are consistent with the 2005 Community Profile. Housing is listed far
above transitional housing, while emergency shelter is not found among the responses.

Needs assessments or surveys conducted among low income and homeless persons in
Houston consistently find that bus tokens or transportation are listed in the top five
services. This is attributable to the fact that gaining access to the most basic survival
services is dependent upon being able to travel to providers. The need for medical
care, while a lower percentage than in the Community Profile is ranked higher in this
group of respondents, which further identifies the group as chronically homeless and
suggests the dire circumstances under which they live.

                                Service                Percent
                              Bus tokens                59.3%
                                Housing                 39.6%
                                Medical                 38.5%
                                Clothing                29.7%
                                 Food                   27.5%
                             Job placement              26.4%
                              Dental care               23.1%
                              All services               6.6%
                                  GED                    6.6%
                        Mental health treatment          6.6%
                        Drug/Alcohol treatment           5.5%
                          Transitional housing           4.4%
                           Veterans benefits             2.2%
                                                                   Observations from the Pierce
                                                                                             12



Case manager responses

The intake process also involved requests that case managers offer general
observations about the clients whom they interviewed. Thirty-three case managers
provided the information. The emergent themes can be interpreted as a continuum of
adjustment with “Unstable” representing the lower end of adaptation through
“Adjusting,” then “Stabilized” and finally, “Motivated.”


      Theme                         Definition                          Example
                     •   Case managers observe behaviors
                         that indicate that client is struggling
                                                                 “He is upset, agitated
                         to adjust to new circumstances.
      Unstable                                                   and said he is losing
                         Includes signs that client was under
                                                                 patience.”
                         the influence of intoxicants during
                         the interview.
                                                                 “She says that she is
                     •   Case managers cite behaviors in
                                                                 becoming more
                         the client that suggest that he/she
                                                                 comfortable, but has
     Adjusting           is attempting to adapt to the new
                                                                 not followed through
                         living conditions, but may be
                                                                 with any of the
                         encountering difficulties in doing so.
                                                                 referrals.”
                     •   Clients reported, or case managers
                         observed that clients demonstrated “Much calmer and
                         behaviors that suggested that they well-groomed…states
     Stabilized          were acclimated to their new            that he is happy with
                         environment and were considering improved living
                         potential service and housing           condition.”
                         options.
                     •   These clients were reported to be       “Client appears to be
                         actively involved in creating options eager to make the
                         to participate in whatever services     best of the opportunity,
     Motivated
                         were deemed necessary for them          states he wants to get
                         to transition to more permanent         a job and find a place
                         housing.                                to live.”
                     •   Client and case manager were not        “Have not been able to
    Unavailable          able to meet, most often because        contact client. He is
                         client did not keep appointments.       not in his room.”
                                                                     Observations from the Pierce
                                                                                               13


Although the low number of respondents inhibits generalization of the findings, it is
noteworthy that more than one-third of the case managers described their clients in
terms that can be categorized as “motivated” to improve their living conditions.


                              Case manager observations

                             36.4%




                                           21.2%
               18.2%
                                                                       15.1%

                                                         9.1%




              Adjusting     Motivated    Stabilized   Unavailable    Unstable

                                           Percent




Conclusions

The words of the clients who participated in the Pierce relocation challenge myths
surrounding homeless persons. No one offered the opportunity to leave the Pierce area
refused the offer. Many shared with case managers that they were living on the streets
because they believed that they had no other option. Consistent with recently conducted
community research on homelessness, most respondents indicated that they became
homeless because of a job loss. Of those who requested services, job placement was
ranked immediately after those that addressed basic survival needs.

Implications for service providers course through the data. Among the most interesting
findings is that the clients in this project chose to live under the Pierce in order to from
or maintain relationships with other homeless persons. Further, they considered these
relationships in their choice of where to relocate. This affiliation also helps explain the
degree to which respondents noted that they felt safer in this encampment than in other
sites, or even in some cases, in shelters.
                                                                      Observations from the Pierce
                                                                                                14


Of note also, is the degree to which clients reported desperation and passivity so
consistent with depression. The presence of depression can greatly hinder the
homeless person’s ability to participate in the activities necessary to survival let alone to
exit homelessness. This assertion is obviously also true when the client is faced with
other mental illnesses, substance abuse or medical disability.

Yes despite this, respondents frequently indicated optimism and motivation for self-care.
For example, both in their choice of living at the Pierce and in the site for their
relocation, many wanted to be located near service agencies, in order to receive
assistance not only for basic needs but for treatment for the range of challenges they
face.

This pilot project offered hope to 178 persons who were chronically homeless. Though
most understood that forces beyond their control initiated the need for their relocation,
they characterized the intervention by the Coalition as an opportunity to improve their
lives. Over time, the repetition of the intervention with the collaboration of service
providers and an on-going assessment of the factors critical to engaging and supporting
participants in leaving the streets will validate that hope.
                                      OPEN DOORS
               Recovery efforts for Hurricane Evacuees relocated to Houston



Essential Findings and Interpretation

More than 5,300 survey respondents who represented over 19,000 evacuees participated in the
study that was conducted from September 7 through October 7, 2005.

•   By the final week of the study, 50% of Katrina evacuees now report that they intend to
    reside in Houston permanently, a rate that has risen from 36% in the first week of the
    surveying. Among Rita evacuees, the rate is 24%. (see chart below)
            Interpretation
            The change in rates came as more individuals who originally had intended to return
            to New Orleans, realized that this would not likely be possible. Rates of respondents
            who indicated that they were unsure whether they would stay or who had decided
            that they would not reside in Houston did not change over the course of the study.

•   Fifty-seven percent (57%) of the families represented in the sample (evacuees from both
    Hurricanes), reported that they were accompanied by children under 18—an average of 2.2
    children per family, Thirty-nine percent (39%) were traveling with other adult relatives—an
    average of 3.9 per family unit.
            Interpretation
            The evacuees traveled as multi-generational family groups. Many respondents told
            interviewers that they had left with elderly parents, grandparents, aunts and uncles
            as well as their children.

•   Since coming to Houston, 46% of respondents who are Katrina evacuees have stayed with
    family or friends as have 60% of Rita evacuees. Over 30% of Katrina evacuees and 29% of
    Rita evacuees have resided in hotels.
            Interpretation
            Interviewers were told, and service providers confirmed, that evacuees are also
            alternating between hotels and the homes of friends and family, especially those who
            evacuated in larger, extended family groups.

•   Prior to coming to Houston, 70% of Katrina evacuees who plan to stay here were employed
    full time and an additional 9.8% were employed part time. The full time employment rates
    for Rita evacuees was 66.2%, while 13.2% were employed part time.
             Interpretation
             Unemployment rates among respondents was 4.3% for Katrina evacuees and 6.3%
             among Rita evacuees. (see chart below)

•   Prior to the Hurricane, the average household income of Katrina evacuees was $19,406, for
    Rita evacuees, household incomes averaged $20.978.
            Interpretation
            Although working, respondents report low wages. It is important to note that those
            evacuees with higher incomes were not likely to have been surveyed, since they less
            commonly sought services through the Disaster Recovery Center or the other sites
            where the research was conducted. (see chart below).



                                               -1-
•   At least 68% of Katrina evacuees who plan to reside in Houston will be seeking full time
    employment, as will 51% of the Rita evacuees who are staying. Approximately 4% of both
    groups will attempt to secure part time work. At the they were surveyed, 4.2% of the Katrina
    evacuees and 4.6% of the Rita evacuees were already re-employed. (see chart below)
            Interpretation
            A proportion of those who are re-employed worked in New Orleans for companies
            that provided new jobs for evacuees here. It is also important to note, as shown in
            the chart below, that the rates of unemployment are relatively low and that among
            those who are not employed full time or part time are homemakers, students, retirees
            and disabled persons.

•   The poverty rate in New Orleans prior to Hurricane Katrina was approximately 30%. Katrina
    evacuees reported that prior to coming to Houston 28.4 were receiving food stamps.
    Hurricane Rita evacuees cited a 22.5% rate.
           Interpretation
           The rates at which people apply for and receive food stamp assistance can be an
           effective marker of poverty rates and is a form of assistance used by the working
           poor.

•   The 5 most needed services designated by Katrina evacuees were: (see chart below)
           Housing voucher         84.6%
           Financial assistance    75.5%
           Food assistance         70.3%
           Rental assistance       67.8%
           Clothing                60.0%

•   The 5 most needed services designated by Rita evacuees were: (see chart below)
           Financial assistance    80.4%
           Food assistance         80.3%
           Clothing                59.2%
           Rental assistance       57.8%
           Transportation          40.0%

•   A separate survey of social service providers ranked the 5 most essential needs of their
    clients. These included:
             Housing
             Employment resources
             Behavioral health care
             Emergency basic services (food, clothing, shelter)
             Support services
                   Transportation
                   Child care
                   Medical care


Summary finding




                                               -2-
Prior to coming to Houston, most of our new neighbors were employed, housed and
independent members of their communities—and they intend to re-establish themselves as
such here.
Priorities for Consideration

•   Intensive case management to assist evacuees to efficiently access services that are
    needed to re-establish their independence
•   Infrastructure for self-sufficiency including job development, employee recruitment, job
    training or re-training
•   Resiliency counseling, especially targeted to assist evacuees to minimize long-term effects
    of grief and trauma
•   Asset building that focuses on enabling evacuees to obtain employment, acquire public
    support, such as FEMA benefits and to engage the strengths that enabled them to live
    independently prior to their relocation
•   Services to special needs populations that enables evacuees to live with the least restriction
    and achieve their optimal level of self-sufficiency whatever that may be
•   Health care and prevention services to prevent deterioration of health or mental health


Support for the Study

The study was conducted with the support of the Houston Downtown Management District and
United Way of the Texas Gulf Coast.

Methods
Surveying was conducted at 10 sites listed in the chart below from September 7 through
October 7. The surveys were administered by intake staff at the respective agencies and by a
team of participants from the Compensated Worker Therapy program of the Michael E.
DeBakey Veterans Administration Medical Center in Houston. The design and analysis of the
study was provided by a Research Professor at the Graduate School of Social Work at the
University of Houston.

Data charts and graphs


                                          Survey site
                         • FEMA (3 sites)                • Chinese Community
                         • Catholic Charities of           Center
                           Galveston/Houston             • Northwest Assistance
                         • Houston Area Urban            • Ministries
                           League                        • Fort Bend Resource
                         • Red Cross Shelter               Center
                                                         • St. Laurence Catholic
                                                           Church




                                                   -3-
       Staying in Houston
                      H Katrina      H Rita
  Permanently             43.7%          24.1%
     Return               20.0%          26.8%
     Other                 5.5%          14.6%
       No                  5.2%          13.2%
  Do not know             25.6%          21.3%




Previous employment status
        Type              H Katrina       H Rita
      Full time               70.0%       66.2%
      Part time                   9.8%    13.2%
    Homemaker                     1.9%      2.1%
      Student                     3.4%      2.7%
       Retired                    4.1%      3.4%
Disabled, not working             6.2%      6.1%
    Unemployed                    4.3%      6.3%




      Seeking Employment
         Type            H Katrina   H Rita

       Full time            68.2%        45.7%

       Part time             4.7%        3.6%

   Already employed          4.2%        4.6%

          No                13.3%        27.0%

     Do not know             9.5%        19.1%




                   -4-
     Previous services
  Service     H Katrina   H Rita
  Housing          6.3%       9.4%
   TANF            1.5%       3.5%
Food stamps      28.4%       22.5%
    SSI          13.3%       13.3%
   SSDI            6.4%       9.1%
VA Benefits        2.3%       4.9%
  Medicaid       23.0%         25%
 Medicare          6.6%          9%




              -5-

								
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