Our nation’s homeless population is rapidly aging. The older homeless are largely young baby boomers who grew up during a time when the country experienced back-to-back recessions and a crack-cocaine epidemic. As highlighted in an article in The Nation, other causes include years of trickle-down economics, welfare cutbacks, increasing income inequality, the disappearance of unions, and the privatization of public services.
Dennis Culhane, PhD, from the University of Pennsylvania, predicts that this trend of older homeless individuals is likely to continue as many youth growing up in foster care or in juvenile justice systems, as well as new Veterans returning to civilian life, face challenges finding employment and housing and are therefore increasingly at risk for experiencing homelessness. Additionally, while recent initiatives to develop alternatives to incarceration have decreased the prison population, individuals reintegrating into society are often unprepared for life outside of prison and find themselves homeless or unstably housed.
In 2014, there were 306,000 people over 50 living on the streets, which is a 20% increase from 2007. People over 50 constitute 31% of the U.S. homeless population, a NY Times article points out (see also The Annual Homeless Assessment Report by the Department of Housing and Urban Development). A large majority of the older homeless population have been on the streets for a significant portion of their lives and often have complicated health issues that are difficult to address while living on the streets.
Life on the streets would be hard on anyone’s body, but for older adults who have spent many years homeless it can be physically debilitating. Without regular access to a doctor, the consequences of living on the streets are extreme and can result in frequent visits to an emergency room for serious conditions, such as chronic pain and diabetes. A lack of healthcare often has homeless individuals in their 50s experiencing health problems similar to housed individuals in their 80s.
Advocates for the homeless point out that this problem is causing the cost of healthcare and social services to rise, which is creating a public health and policy crisis. Many point to permanent supportive housing as the solution to this problem, a solution that combines affordable housing with support services. If older homeless individuals are given homes, their health might not deteriorate as quickly and they may need fewer social services. Supportive housing has been instrumental in greatly reducing the number of chronically homeless individuals over the last decade.
To prevent the new trend of chronically homeless adults, Dennis Culhane recommends a wider range of preventative services to target populations at-risk of homelessness, including short-term emergency housing assistance, ongoing housing, financial, and educational supports for young adults, prison reentry programs, and Veteran support programs.
Ben Henwood, PhD, from the University of Southern California Suzanne Dworak-Peck School of Social Work, is studying ways to make supportive housing services more suitable to the needs of older adults. He’s leading a two-year project to explore ways to reduce the gaps between the needs of L.A.’s older chronic homeless population and existing housing and support service options. This study focuses on health symptoms, such as delirium, falls, incontinence, and frailty, that are frequently found in older adults but are not specific disease categories. The goal is to provide data on how addressing age-related health conditions can be integrated into housing services and how to adapt screening services for the elderly in non-clinical settings.
Blog Post Author: Kelsey Whittington, MSW, graduate assistant for the National Center for Excellence in Homeless Services.
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Check out this one about employment support programs for people experiencing homelessness.
Binghamton University Hosts Film Screening and Panel Discussion to Raise Awareness about Homelessness
This past November 18th, in recognition of National Hunger and Homelessness Awareness Week, faculty and students from Binghamton University’s Department of Social Work collaborated with the Southern Tier Homeless Coalition to host a screening of the film Tiny: The Life of Erin Blackwell. A panel presentation and community conversation followed to raise awareness of homelessness, its potential ramifications, and to identify next steps. Binghamton’s mayor, Rich David, opened the event with a brief speech about his ongoing efforts to address homelessness.
The film follows the continuing life story of Erin Blackwell, who was first introduced to audiences 20 years ago in director Martin Bell’s Streetwise, a documentary about youth homelessness. Bell’s follow-up documentary profoundly chronicles the resilience and ongoing traumas encountered by the protagonist over the course of two decades.
The panel included:
- Cassandra Bransford, Associate Professor of social work at Binghamton University and faculty contact for the National Center, who served as moderator;
- Shari Weiss, President of the Executive Board and Chair of the Southern Tier Homeless Coalition, who spoke about developing community partnerships to end homelessness;
- David Wallace, Clinical Director at the LaSalle School (Albany, NY), who spoke about trauma, homelessness, and youth;
- Jessica Peruse, Homeless Team Leader at the VA Medical Center (Syracuse, NY), who spoke about the Housing First model; and
- Jed Metzger, Associate Professor of social work at Nazareth College and the school’s faculty contact for the National Center, who spoke about what we can do to end homelessness and poverty.
The panelists presented their perspective following the screening, answered audience questions, and encouraged audience members to get involved. Continuing education credits were offered to social workers for attending. The event was otherwise free and open to the public.
Donations were solicited for the ongoing Freeze Fund initiative. Both prior to and during the event, students collected non-perishable food items, toothbrushes, socks and foot warmers to hand out in care packages to community members over the frigid winter months.
Ending Homelessness in Binghamton
The city of Binghamton has long been on the forefront of the struggle to eradicate homelessness. In late 2014, Mayor David announced a landmark accomplishment in this effort as part of the national Mayors Challenge to End Veteran Homelessness. On a single night across the city, not a single veteran experienced unsheltered homelessness, earning Binghamton the distinction of being the first city in the country to meet the Mayors Challenge.
These efforts continue to this day, led in large part by the Southern Tier Homeless Coalition, which coordinates services and conducts the yearly point-in-time count. The Coalitions’ work helps provide critical support to the community and gathers crucial data to secure funding for services both in urban Binghamton and in the surrounding rural counties.
Advancing Social Justice Together
This event supports the American Academy of Social Work and Social Welfare’s Grand Challenge to End Homelessness and aligns with CSWE’s fifth core competency – advancing human rights and social and economic justice. Homeless or otherwise, our most vulnerable community members deserve better, and it is our responsibility as social workers to help build a social safety net to protect them. This event to raise community awareness is only one step in the broader struggle to end homelessness.
Ultimately, ongoing collaboration among stakeholders is key. Rebecca Rathmell, the Southern Tier Homeless Coalition’s coordinator, said it best:
“It has to be a collaborative effort and everything from street outreach and making sure we’re identifying the youth and the families experiencing homelessness all the way to permanent support of housing.”
We were grateful to be able to collaborate to make this event happen and we at Binghamton University are looking forward to future opportunities moving forward.
About the Author: Michael Cole is a second-year master’s student and Graduate Assistant at the Binghamton University Department of Social Work. He is currently interning at the UHS Wilson Medical Center. In his spare time, he enjoys baking and blogging about social justice.
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Check out this one written by Robin Petering, doctoral candidate at the USC Suzanne Dworak-Peck School of Social Work.
I am fortunate to be a co-Investigator on the Homeless Risk and Resiliency Survey, which is a multi-city assessment of the behaviors and experiences of homeless and unstably housed youth. This past summer myself and my team collected qualitative interviews with a subset of the youth participants in Los Angeles. One of the questions we asked seemed overtly simple for a research question. We asked everyone: “If you woke up tomorrow and your life was exactly the way you wanted it to be, what would it look like?” The answers we got were endearing, funny, honest, and inspiring. Some really pulled on the heartstrings, but as a whole, the answers provided an honest picture of the hopes and dreams of youth experiencing homelessness or housing instability.
In writing this piece, I asked myself the same question. If I woke up tomorrow and my life was exactly the way I wanted it, I would be living on the West Coast in my own home, I would be surrounded, supported, challenged and inspired by family and friends, I would be working towards a career that makes me happy and gives me purpose, and myself and the one’s I love would be healthy. Over the course of my life, I’ve been asked and have answered this question many times. Each time, my answer changes. The more times I articulate my answer to this question, the closer my answer gets to my reality. With each contemplation, I get a new opportunity to reflect on my core values and identify what are the most important things I want in my life. Homeless and unstably housed youth deserve these opportunities as well. I feel that sometimes as service providers and researchers we can get caught up in the minutia. So keep asking the simple questions and ask them over and over again.
Below is my favorite quote from the interviews:
“I would be in a queen size bed firm but soft, my bills would be paid off, my storage unit that I have would be paid off for like five years, I would have my associates degree and would be working on my masters no bachelors in law or criminal justice anything crime wise, um yeah that’s pretty much it. And I would still be advocating for the underdogs somehow. But all that if I just woke up tomorrow and all that happened it would feel great but it would be hollow. ‘Cause no effort was put into filling it up and making it solid. I wished it but the outer shell is there. The process is that makes it sweeter. I want to fill it up that shell with the blood sweat and tears of me getting there. It would be lovely if that just happened and kind of I wished it did. I would get over the hollow feeling but pretty much yes. I have to work for it because I feel like it will be snatched away if I don’t.”
Scroll down to see more quotes from the youth interviewed, and you can download a pdf of them here.
Note: The Homeless Youth Risk and Resiliency Survey (HYRRS) investigators include Anamika Barman Adhikari, Kimberly Bender, Hsun-ta Hsu, Kristen Ferguson, Sarah Narendorf, Diane Santa Maria and Jama Shelton.
About the Author: Robin P. Petering, MSW is a PhD candidate in the USC Suzanne Dworak-Peck School of Social Work. Her research interests center on understanding the social determinants of risk behaviors among vulnerable youth. She is a co-Primary Investigator on a multi-city study assessing the health risks and resiliency of homeless and unstable housed young people. She also recently received an NIH fellowship to support her research on gang-involved homeless youth.
The Future of Innovation Lies in Collaboration – USF Social Work and Engineering Students Pave the Way
The 2016 Hackathon Codapalooza, sponsored by the Tampa Innovation Alliance, took place over the weekend of June 3-5, 2016, where diverse groups of individuals came together for 72 hours to respond to the challenge to design an app to help the region’s homeless population. The University of South Florida’s team (Team USF), composed of students from the College of Engineering and the School of Social Work, represented a unique and wide range of skills sharing one common goal—a desire to use their education and passion to help ease a problem faced daily by those on the streets.
The team (pictured left) began their collaboration with a discussion on the epidemic of homelessness overall. For some engineering students, this was their first time hearing about the realities that the community faces. For these students, hearing the answers only prodded more questions—about topics like federal funding, shelters, and housing vouchers. As the social work students presented case examples of the difficulties accessing resources and the impact of the lack of funding dedicated to help this vulnerable population, it was clear that the engineering students were feeling a variety of emotions. Ultimately, this made them eager to learn more and above all determined to find a worthwhile solution at this event. The social work students were eager to provide information on the current status of the homeless, not only from the factual laws and regulations perspective but also from their view of raw, first hand experience gained from working directly with Tampa’s homeless population. They knew the reality of what was most needed and practical in the community.
The social work students told many stories of homeless people being unable to find an open shelter bed. And, if they did, being tired of waiting in lines all day trying to secure a bed only to find they did not qualify, because shelters often have admission criteria for special subpopulations of homeless people. For example, perhaps he or she is not a veteran, not disabled, not a woman with children, or doesn’t meet any of the other possible prerequisites for a shelter. This is what ultimately led to the app that Team USF created.
This is how the general idea of the app would work. Users would be prompted to answer a series of questions (e.g. gender; age; if accompanied by children, how many and how old; veteran status; disability status, etc.). Once the information was processed, a series of shelters they qualified for would pop up, based on their GPS location, along with the addresses and phone numbers.
The engineering students, as they were developing the app, went step-by-step through the coding process with the social work students. While they possessed so much technical skill, the social work students would remind them about nuances within the homeless community that made designing this app different from any other. For example, the coders assumed after the user downloaded the app that they would create a login, as one would do with most apps and websites. However, the social work students made the engineering students aware that the homeless population is already wary of authority.
The realization of the need to protect personal information infused the conversation as engineers realized the sensitivity of the state of homelessness. The login idea was nixed. After that, the coding students began speaking in highly technical jargon about html, and the social work students eagerly inquired about what specific terms meant—respect and admiration in their voices, an exact replication of the excitement the engineering students had when learning about the needs of the homeless. Both the engineering and social work students wanted, with such fervor, to ensure the app went beyond just the Hackathon, and that it could actually be implemented as a helpful tool for a community desperately in need.
Team USF presented their app at the conclusion of the event. As they showcased their prototype, it was clear that each decision made for the app was a deliberate one and one that was discussed and explained in great detail within the group. From the minute they started, there was a practical and thoughtful reason for every decision made. The decision to make the app for Android phones, for example, was because it was mentioned that a vast majority of the homeless do not have iPhones, and thus it would be less important to make the app Apple-friendly. Every choice being a conscious one was a huge aspect of what made the process so invigorating. The app was clearly tailored to the user and provided access to an important service.
Overall, the Hack for Homelessness event is part of a bigger picture of “Hack For” events that are changing the world. Every team participating created something useful that did not already—but absolutely needs to—exist. This event facilitated integral dialogues between social workers and coders and, most importantly, collaboration in the face of determination. It showed how eager people are to learn about other fields. Social workers and engineers both work to solve big social problems. More opportunities to collaborate like this are needed to do just that.
About the Author: Erin Fowler (pictured right) is a third-year senior at the University of South Florida studying mass communications and interning at Moffitt Cancer Center. In her spare time, she enjoys doing yoga and building her book collection.
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Check out this one written by Kelsey Whittington, UAlbany MSW student and graduate assistant for the National Center for Excellence in Homeless Services.
We have made meaningful progress over the past decade in addressing chronic homelessness in the United States, as evidenced by a 35% reduction between 2007 and 2016 in the number of persons experiencing chronic homelessness on a single night. The significant expansion of permanent supportive housing (PSH) over this time period is rightly credited as driving this progress and helps illustrate what is possible if resources are directed towards evidence-based, housing-focused solutions.
Yet, PSH should not be understood as a one-size fits all solution to homelessness. With annual costs that can exceed $15,000, it is a resource-intensive intervention, and it may not be feasible or necessary to provide such an intensive intervention to all persons experiencing homelessness. Alternative solutions that are less resource intensive, but equally effective as PSH, are therefore sorely needed for the bulk of the homeless population who experience short-term or “crisis” homelessness. For these individuals (who make up about 85% of the overall sheltered homeless population), an episode of homelessness is often triggered by an event such as an eviction, dissolution of a relationship, or transition out of an institutional living arrangement, such as foster care, prison, inpatient hospitalization, or substance abuse treatment. Unfortunately, progress in addressing crisis homelessness has not kept pace with that made on chronic homelessness: after subtracting out reductions in chronic homelessness, between 2007 and 2015, there was only a 6% decline in homelessness among single adults.
Fortunately, the emergence of a new paradigm in the homelessness assistance sector focused on housing stabilization, coupled with recent Medicaid policy developments, provides a unique opening for substantial progress to be made in reducing crisis homelessness. Recognizing this opportunity, my colleague Dennis Culhane and I recently presented a proposal to leverage the evidence-based intervention Critical Time Intervention (CTI) as a means to expand the availability of rapid re-housing—a promising new strategy that focuses on providing short-term, highly flexible assistance to help homeless households quickly achieve housing stabilization—for persons experiencing crisis homelessness.
Adapting CTI into a large-scale rapid re-housing intervention would make for a sound and feasible policy response to crisis homelessness for several reasons. First, the CTI and rapid re-housing conceptual and program models align nearly perfectly, meaning that a CTI-based rapid re-housing program model would be fairly straightforward to implement. Second, CTI has a strong evidence base as an effective intervention for reducing homelessness, and an integration of rapid re-housing and CTI could therefore amplify the impact of existing rapid re-housing programs. Third, recent guidance issued by the Centers for Medicaid and Medicare Services (CMS) suggests that most of the services at the core of a CTI-based rapid re-housing program could be reimbursed by state Medicaid programs, thereby providing the necessary funding to scale-up the approach with federal resources.
Implementing a CTI-based rapid re-housing at a large scale would have benefits at multiple levels. First, at the individual level, the housing stability and connections to community-based treatment and supports afforded by CTI would lead to improved health, economic, and social outcomes. Second, from the perspective of health care systems, and Medicaid in particular, the expansion of CTI-based rapid re-housing services could lead to more efficient and effective use of health care dollars. Third, the implementation of our proposal would have a number of potential benefits to society, the most notable of which would be a substantial reduction in overall homelessness. Society would also benefit from reduced utilization of criminal justice system resources, public assistance, and other public services, as CTI has been linked with reductions in such services.
To be sure, there are challenges that would need to be addressed in implementing this idea. These include the need to appropriately tailor CTI for those experiencing crisis homelessness; having a trained workforce in place to deliver CTI-based rapid re-housing at scale; determining the best mechanism for states to include CTI in their Medicaid benefit package; and resolving how to pay for the temporary financial assistance component of rapid re-housing.
Fortunately, there is important work already being done to address these challenges and figure out how best to integrate CTI and rapid re-housing. Most notably, in a project supported by the Melville Charitable Trust, the Center for the Advancement of Critical Time Intervention is partnering with the National Alliance to End Homelessness to develop and test an integration of CTI into rapid re-housing programs in Connecticut. Such work is crucially important and holds great promise. To make real progress in addressing crisis homelessness similar work should be actively encouraged.
About the Author: Tom Byrne is an Assistant Professor of Social Welfare Policy at the Boston University School of Social Work. He is also an Investigator at the U.S. Department of Veterans Affairs’ National Center on Homelessness Among Veterans.
Chronic unemployment or sudden job loss can lead to homelessness. For individuals able to work, regaining a steady job can make it easier to exit homelessness and can support long term housing stability and financial security. However, homeless people often face many obstacles when searching for and maintaining employment. Many have limited skills, education, and experience, and opportunities for jobs that pay a living wage can be limited. The lack of a car or access to public transportation is an additional barrier. However, research has shown that the homeless, both those who are chronically and acutely homeless, are willing and able to work if given the opportunity. Gary Shaheen and John Rio present a thoughtful argument for the role of employment in preventing and ending homelessness.
EMPLOYMENT SERVICE MODELS
Multiple models have been developed to provide employment services to people experiencing homelessness. Several of these models stress the importance of job training in the employment process. For example, the Coalition for the Homeless in New York City has a First Step Job Training Program that provides homeless and low-income women with training, social support, education, and work experience to overcome obstacles to employment. This program offers classes that teach employment skills and an understanding of the labor market and workplace.
Supported Employment is an evidence-based practice that stresses the importance of obtaining employment through a rapid job search as soon as the participant feels ready. Unlike many traditional models, supported employment does not provide lengthy pre-employment assessment, training, and counseling. Rather, evidence suggests that rapid access to jobs is more effective than providing extensive job-readiness training. The most common model of supported employment, the Individualized Placement Support (IPS) model, helps individuals gain rapid entry into the job market, with a job at or above minimum wage, while providing supportive services. These services typically include one-on-one job coaching, on-the-job training and credentialing, mental health treatment, and ongoing reassessment to identify and address emerging barriers. The National Coalition of Homeless Veterans successfully uses an IPS supported employment model for the veterans they serve.
WorkFirst is an employment model that draws on IPS principles and is designed to operate parallel to housing first efforts. It prioritizes employment as a strategy for promoting self-sufficiency and long-term housing stability. The WorkFirst model, like supported employment, stresses the importance of rapid access to a job. This model’s philosophy is that “any job is a good job” and that the best way to prepare an individual for work is to have them work, and as quickly as possible. Clients develop work skills and competencies on the job rather than in job-readiness trainings. If one is not able to find employment right away, WorkFirst provides additional services to address factors that impede employment, such as education or training, but these are brief in nature to allow the job search to quickly recommence. A WorkFirst Demonstration Project at the Pine Street Inn in Boston is a great example of how effective this method can be.
In addition to these formal models, communities across the country are developing innovative ways to increase employment opportunities for people experiencing homelessness. For example, the Interfaith Partnership for the Homeless in Albany, NY started the Ambassador program, a year-long training program that connects homeless individuals to work in the community while also helping them pursue life goals and gain important skills. The program partners with local theaters and parks to provide homeless people with a job, often their first job, which helps them get a second job in the future and builds their resumes. The There’s A Better Way program in Albuquerque similarly provides access to jobs beautifying the city, such as landscaping and cleaning up litter.
These are just a few examples of employment services and supports for people experiencing homelessness. To learn more about these and other models, click here for a quick overview or here for a closer look at how employment can prevent homelessness and promote health.
Blog Post Author: Kelsey Whittington, graduate assistant for the National Center for Excellence in Homeless Services.
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Check out this one written by Dr. Emmy Tiderington from Rutgers University.