Homeless Populations
Homeless Populations.
Chapter 22
Homeless Populations
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Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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
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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)
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Defining Homelessness (Cont.)
ETHOS Types of Living Situations
Rooflessness
Houselessness
Insecure housing
Inadequate housing
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Defining Homelessness (Cont.)
Canadian Homelessness Research Network (2012) defined four major categories based on ETHOS:
Unsheltered
Emergency sheltered
Provisionally accommodated
At risk of homelessness
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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
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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
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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)
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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)
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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)
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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.
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Copyright © 2015, 2011, 2007, 2001, 1997, 1993 by Saunders, an imprint of Elsevier Inc.
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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)
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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)
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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.
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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
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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
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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
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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
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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
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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
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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)
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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
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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
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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)
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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)
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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
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Table 22-2 http://www.healthypeople.gov/2020/about/DOHAbout.aspx
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| 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.
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