Homeless Populations


Chapter 22

Homeless Populations

 

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

1

 

Recent Efforts to Count Homeless

Homeless Information Management System (HMIS)

Directed by Congress to gather homeless data

Continuum of Care (CoC) concept

One-night point-in-time (PIT) count

Annual estimate based on reports of service use

A “snapshot” picture of the homeless population

National Alliance to End Homelessness (NAEH) and Housing and Urban Development (HUD)

U.S. Conference of Mayors

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

2

2

 

Defining Homelessness

ETHOS perspective: Home has three domains:

Physical—adequate dwelling for which a person/family has exclusive possession

Social—being able to maintain privacy and enjoy relations

Legal—having exclusive possession, security of occupation, and legal title to occupation

ETHOS = European Typology of Homelessness and Housing Exclusion

– European Federation of National Associations

Working with the Homeless (2011)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

3

Defining Homelessness (Cont.)

ETHOS Types of Living Situations

Rooflessness

Houselessness

Insecure housing

Inadequate housing

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

4

Defining Homelessness (Cont.)

Canadian Homelessness Research Network (2012) defined four major categories based on ETHOS:

Unsheltered

Emergency sheltered

Provisionally accommodated

At risk of homelessness

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

5

HUD Legal Definitions in the United States

Category 1. Literally Homeless. Individuals and families who lack a fixed, regular, and adequate nighttime residence and includes a subset for an individual who resided in an emergency shelter or a place not meant for human habitation and who is exiting an institution where he or she temporarily resided

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

6

HUD Legal Definitions in the United States (Cont.)

Category 2. Imminent Risk of Homeless. Individuals and families who will imminently lose their primary nighttime residence

Category 3. Homeless Under Other Federal Statutes. Unaccompanied youth and families with children and youth who are defined as homeless under other federal statutes who do not otherwise qualify as homeless under this definition

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

7

HUD Legal Definitions in the United States (Cont.)

Category 4. Fleeing/Attempting to Flee Domestic Violence (DV). Individuals and families who are fleeing, or are attempting to flee, domestic violence, dating violence, sexual assault, stalking, or other dangerous or life-threatening conditions that relate to violence against the individual or a family member.

– U.S. Department of Housing and Urban Development,

Office of Community Planning and Development (December 5, 2011)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

8

Definition of Homeless Student

McKinney-Vento Homeless Education Assistance Improvements Act of 2001 ensures that each child and each homeless youth has equal access to the same free, appropriate public education, including a public preschool education, as provided to other children and youths.

Includes children and youth who are:

Sharing the housing of other persons (frequently referred to as “doubling up”)

Abandoned in hospitals

Awaiting foster care placement

– U.S. Department of Education (2001)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

9

DHHS Definition of Homelessness

Runaway Youth is “. . . a person under 18 years of age who absents himself or herself from home or place of legal residence without the permission of his or her family”

Homeless Youth is “. . .a person under 18 years of age who is in need of services and without a place of shelter where he or she receives supervision and care”

– U.S. Department of Health and Human Services,

Administration for Children & Families, Family and Youth Service Bureau (2012)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

10

Prevalence of Homelessness

Point-In-Time (PIT) count of sheltered homeless people on a single night in late January of every year and submit this data to HUD—use data to prepare an Annual Homeless Assessment Report (AHAR)

Department of Education includes youth and families for services through Education for Homeless Children and Youth (ECHY) program

Conference of Mayors’ Hunger & Homelessness Survey gathers data for their cities each year

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

11

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

12

Table 22-1

PIT Estimates of Homeless People January 2012
Population Sheltered & Unsheltered Single Night January 2012 Change Years
Households
Individuals 394,379 -6.8% 2007-2012
Families with children 239,403 -3.7% 2007-2012
Total 633,782 -5.7% 2007-2012
Subpopulations
Veterans 62,619 -17.2% 2009-20123
Chronically homeless 99,894 -19.3% 2007-2012
Estimates of Homelessness, Retrieved September 2013 from http://abtassociates.com/CMSPages/GetFile.aspx?guid =77fdb6fa-6e6b-4524-8b5a-8e68c68caca9.

We would be wise . . . to avoid the numbers game. Any search for the “right number” carries the assumption that we may at last arrive at an acceptable number. There is no acceptable number. Whether the number is 1 million or 4 million . . . there are too many homeless people in America.

– Kozol (1988)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

13

13

 

Demographic Characteristics

Based on Jan 2010-2011 reports on homeless:

More men than women

Women head up more single families

Younger than general population

Minorities were overrepresented

Disability rate twice that of all families

Veterans were primarily male

– U.S. Department of Housing and Urban Development, Office of Community Planning and Development (2008)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

14

14

 

Factors That Contribute to Homelessness

Shortage of affordable housing

Income insufficient to meet basic needs

Inadequate and scarce support services

Note: Factors contribute to homelessness rather than cause homelessness.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

15

 

HHS Homeless Services

Federally Qualified Health Centers (FQHC) and FQHC Look-A-Likes

Provide services to generally underserved populations (low income)

Health Care for the Homeless

Provide primary health care and substance abuse services to homeless populations

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

16

Health Status of Homeless Adults

Homeless population experience morbidity rates that are higher than those occurring in comparable groups in the general population.

Acute physical health problems (including respiratory and trauma)

Chronic disorders and poor dentition

Mental illness and minor emotional problems

Alcohol and drug use

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

17

 

Health Status: Homeless Women

Higher rates of pregnancy (often unintended) with higher preterm births and low-birth-weight infants

More stressful life events, foster care as children, IPV as adults, hospitalization for psychiatric issues

History of violence from childhood to adulthood

High risk for physical and sexual victimization

Women veterans:

Being unemployed, disabled, or unmarried strongly predict homelessness

Many report history of military sexual trauma

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

18

 

Health Status: Homeless Families

Histories of chronic physical and mental health conditions, substance abuse, victimization, and low education and job training of adults are also risk factors for compromised caregiver-child relations

Impact on children:

Affect children’s educational achievements

Missing days of school  repeat grades

Risk of nonacceptance or teasing

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

19

 

Health Status: Homeless Youth

Unintended pregnancy

STDs, physical/sexual abuse, skin disorders, anemia, drug/alcohol abuse, unintentional injuries

Depression; suicidal ideation; disorders of behavior, personality, or thought

Family disruption; school failures; prostitution or “survival sex”; involvement with the legal system

Social health severely compromised

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

20

Homeless adolescents experience health problems from high-risk behaviors at higher rates than the general adolescent population.

 

Chronically Homeless

Unaccompanied adults who are homeless for extended or numerous periods and have one or more disabling conditions

Disabling conditions are often severe mental and substance use disorders

Biological, psychological, and social health is rarely addressed

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

21

 

Framework for C/PHN

Based on principles of Social Justice, the framework emphasizes Upstream Thinking in addressing the SDH (Social Determinants of Health) factors contributing to homelessness. The interventions (from the Intervention Wheel) identified reflected macro-upstream factors and more micro-downstream condition of individuals and families experiencing homelessness.

– Nies & McEwen (2015)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

22

Models of Justice

Market justice system

Dominant model

Belief that people are entitled to valued ends (i.e., status, income, and happiness) according to their own individual efforts

Stresses individual responsibility, minimal collective action, and freedom from collective obligations other than respect for another person’s fundamental rights

Results in a downstream approach to problems

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

23

 

Models of Justice (Cont.)

Social justice system

Belief that all people are equally entitled to key ends (e.g., access to health care and minimum standards of income)

Says all members of society must accept collective burdens to provide a fair distribution of these ends

A foundational aspect of public health

Supports upstream thinking

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

24

 

Social Determinants of Health

Circumstances in which people are born, grow up, live, work and age, and the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.

 

– World Health Organization Commission

on the Social Determinants of Health (2013)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

25

Social Determinants of Health (Cont.)

Healthy People 2020

New goal: to “Create social and physical environments that promote good health for all”

New topic area: Social Determinates of Health (SDH)

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

26

Social Determinants of Health (Cont.)

Five broad dimensions of SDH are defined within Healthy People 2020 as:

Economic Stability

Education

Social and Community Context

Health and Health Care

Neighborhood and Built Environment

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

27

Table 22-2 http://www.healthypeople.gov/2020/about/DOHAbout.aspx

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

28

Social Determinants of Health and Factors Contributing to Homelessness
Health People 2020 Social Determinant of Health Dimensions and Key Issues Factors Contributing to Homelessness
Economic Stability
Poverty Income Insufficiency
Employment Status Income Insufficiency
Access to Employment Income Insufficiency
Housing Stability (e.g., homelessness foreclosure) Shortage of Affordable Housing
Health and Health Care
Access to Health services—including clinical and preventive care Inadequate and Scarcity of Supportive Services
Access to Primary Care—including community-based health promotion and wellness programs Inadequate and Scarcity of Supportive Services

Public Health Intervention Wheel

C/PH Nurses, working downstream with individuals, families, or groups use surveillance, disease, and other health event investigation, outreach, screening, case finding, referral and follow-up, case management, delegated functions, health teaching, counseling, and consultation.

C/PH Nurses working more upstream, at the system level, employ collaboration, coalition building, community organizing, advocacy, social marketing and policy development, and enforcement.

Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.

29

The post Homeless Populations appeared first on Infinite Essays.



Source link

 
"Looking for a Similar Assignment? Order now and Get 10% Discount! Use Code "Newclient"

WhatsApp Inquire from us on matters homework