Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research

Contents

• Introduction
• Lessons of the Past Decade and Future Directions
• Synopses of 2007 Research Papers
  • Historical and Contextual Influences on the U.S. Response to Contemporary Homelessness
  • Changing Homeless and Mainstream Service Systems:  Essential Approaches to Ending Homelessness
  • Consumer Integration and Self-Determination in Homelessness Research, Policy, Planning, and Services
  • People Who Experience Long-Term Homelessness: Characteristics and Interventions
  • Homeless Families and Children
  • Homeless Youth in the United States:  Recent Research Findings and Intervention Approaches
  • Characteristics of Help-Seeking Street Youth and Non-Street Youth
  • Rural Homelessness
  • Incarceration and Homelessness
  • Housing Models
  • Employment and Income Supports for Homeless People
  • Accountability, Cost-Effectiveness, and Program Performance:  Progress Since 1998

Introduction

On March 12, 2007, the U.S. Department of Health and Human Services (HHS) and the U.S. Department of Housing and Urban Development (HUD) sponsored the second National Symposium on Homelessness Research. This publication is a compendium of the 12 papers prepared for and presented at the Symposium.

In 1998, the first National Symposium on Homelessness Research was held in Arlington, VA, bringing together researchers, policymakers, practitioners, and formerly homeless people to review and discuss what had been learned in the decade since the passage of the Stewart B. McKinney Homeless Assistance Act (P.L. 100-77). The McKinney Act provided the first federal funds targeted specifically to address the needs of homeless people. Sponsored jointly by HHS and HUD, the two-day Symposium featured presentations by authors of 11 research papers and facilitated discussions to provide feedback to the authors and Symposium planners. The papers were then revised and published in a compendium titled Practical Lessons: The 1998 National Symposium on Homelessness Research.

Now, 10 years later, the landscape of homelessness research has evolved significantly. New models for housing and service delivery have emerged, and cutting edge research has expanded our understanding of the various populations that experience homelessness. Research on the dynamics of shelter use has yielded important information about the characteristics of single individuals experiencing homelessness and has brought focus to the population experiencing chronic homelessness. Efforts continue within and across federal agencies to standardize homeless-related data definitions and improve performance measurement activities, an example of which is HUDs Homeless Management Information System (HMIS). The Symposium held in 1998 focused primarily on housing and health and human services. While these issues are still central to the issue of homelessness, additional areas relating to employment, veterans, and the criminal justice system are increasingly important to understanding the complexity of homelessness in the 21^st century.

Much research has been accomplished since 1998, but progress has not occurred equally across subject matter since that time. Certain subjects were ripe for analysis in 1998, and policy priorities frequently move research efforts in particular directions. In recognition of this evolution, HHS and HUD sponsored a second National Symposium in 2007 to provide a forum in which to present and synthesize the current state of the art knowledge pertaining to homelessness.

For the 2007 Symposium, the Office of the Assistant Secretary for Planning and Evaluation (ASPE) at HHS and the Office of Policy Development and Research (PD&R) at HUD contracted with Abt Associates Inc. and Policy Research Associates, Inc., to work with staff across several federal agencies and the U.S. Interagency Council on Homelessness to coordinate a second National Symposium, focusing on lessons learned from research and practice since the 1998 meeting. To guide the development of the Symposium, an expert panel was convened to provide input on the format for the event, paper topics, paper authors, and Symposium participants. The members of the expert panel also reviewed and provided comments on draft papers prior to the Symposium.

The members of the expert panel were:

• Martha Burt, Urban Institute
• Dennis Culhane, University of Pennsylvania
• Meredith Deming, Bradenton County Coalition on Homelessness
• Charlene Flaherty, Corporation for Supportive Housing
• Paul Koegel, RAND Corporation
• James OConnell, Boston Health Care for the Homeless Program
• Ann OHara, Technical Assistance Collaborative
• Debra Rog, Westat
• Nan Roman, National Alliance to End Homelessness
• Phyllis Wolfe, Phyllis Wolfe and Associates, Inc.

Teams of authors consisting of leading researchers and practitioners were commissioned to prepare 10 papers for discussion at the Symposium, held March 12, 2007 in Washington, D.C. To supplement these 10 papers, the HHS Substance Abuse and Mental Health Services Administration (SAMHSA) sponsored two additional papers: an eleventh paper focusing on rural homelessness and a twelfth paper written by an emerging researcher (i.e., chosen from among individuals from underrepresented racial and ethnic groups, individuals with disabilities, or individuals from disadvantaged backgrounds) in order to increase diversity on a national or institutional basis in the field of homelessness research. The emerging researcher was competitively selected from a pool of current doctoral candidates and recent doctoral graduates to prepare a paper and presentation for the Symposium. At the Symposium, the paper authors presented their papers, and Symposium participants, comprising over 200 researchers, service providers, consumers and policymakers, provided feedback to the authors. The final drafts of the 12 papers are presented in this compendium.

Lessons of the Past Decade and Future Directions

While the papers commissioned for the 2007 Symposium cover a wide range of topics, two broad themes illustrate how the fields of homelessness research and practice have evolved since the 1998 Symposium.

The emergence and strengthening of new and existing collaborative efforts to address homelessness at all levels of government and among local providers and consumers is a distinguishing feature of the last decade of homeless assistance.  This trend toward systems change and integration contributes to a more holistic view of interventions to mitigate and, ultimately, end homelessness. Examples include the growth and enhancement of continuums of care as organizing structures for combating homelessness, the development of Policy Academies as a tool for prioritizing and coordinating state efforts, the creation of local 10-year plans to end homelessness, and the engagement of mainstream service resources such as Medicaid to expand the services provided through homeless assistance programs. Such collaborative efforts often have other positive results, including attracting new stakeholders that had not previously been involved in homeless assistance networks, as well as increasing resources to fund services and produce housing. Given the fierce competition for the limited supply of low-cost housing for those who are homeless as well as those who are poor and potentially at risk of homelessness, these resources  both organizational and financial  are critical to ending homelessness.

In order to prevent and end homelessness, we know that multiple service systems must work together, and we are beginning to understand effective strategies to make change happen within and across systems. For example, the nexus of incarceration and homelessness  and the movement between these two systems  demonstrates the critical need for collaborative efforts among the criminal justice, housing, and homeless assistance systems. Through coordination among housing, homeless assistance providers, and mainstream family support systems, new approaches are being developed to help families retain housing they may be at risk of losing or to transition quickly out of emergency shelters if they do become homeless. Similarly, practitioners and policymakers are addressing how to coordinate mainstream employment, training, and income support programs with interventions targeted specifically to people who are homeless to enhance work opportunities and increase incomes.

Despite the factors that are promoting collaboration, there remain challenges to true systems change. Homeless assistance services continue to be fragmented in some communities, and the prevalence of renewal grants in HUD programs may have the unintended effect of reinforcing this fragmentation. More broadly, change is hard. A relatively small number of communities have brought together the broad-based coalitions of homeless assistance providers, mainstream service providers, politicians, and the business community that are needed to develop a systemic approach to homelessness. Others have made more modest moves in this direction. Research to document and assess the outcomes of collaborative efforts on the people they serve and on homelessness overall is beginning to emerge, leading to the second theme of the past decade.

The increased emphasis on collecting and using data to understand better the characteristics and dynamics of homelessness is helping the homeless assistance field synthesize research findings, assess what we know, and outline what we still need to learn.  The growing use of Homeless Management Information Systems (HMIS), cost-benefit analyses, and administrative data systems to learn more about what works for whom, and at what cost, is helping move the field from anecdotal to evidence-based approaches. We are better able to address questions about how people who are homeless differ from those who are poor, but domiciled. When fully implemented, HMIS will help document the number of people who are homeless, some of their characteristics, and how they use homeless assistance services over time. Analysis of service utilization and cost data from administrative systems has already furthered our understanding of patterns of homelessness and service use for unaccompanied adults with disabilities. The application of this type of analysis to other subpopulations  such as homeless families  may shed light on how homeless assistance programs can best target housing and service resources to meet the needs of other, less understood groups.

Research tools are evolving and more data are available now than at any time in the past. This allows programs to better target services and respond flexibly to individual needs. However, there is still much to learn. The usefulness of research on homelessness is often constrained by the lack of clear definitions and rigorous measurement of both the interventions (housing and services) and their beneficiaries. We strive to learn what works for whom, but we often fall short in our efforts to measure the what and to characterize the whom. There is a clear need for continued attention to data collection, to the importance of rigorous controlled studies to expand our knowledge, and to the mutual benefits of sharing information between researchers and the field.

The papers presented and discussed at the Symposium and compiled in this compendium are briefly previewed below. Collectively, they offer a cogent summary of how far we have come since the 1998 Symposium, and where we still need to go in homelessness research.

Synopses of 2007 Research Papers

Historical and Contextual Influences on the U.S. Response to Contemporary Homelessness

Walter Leginski reviews the nature of and responses to homelessness throughout the nations history and the evolution of approaches to contemporary homelessness. The author notes that, in the past two decades, a de facto system of service has evolved to apply actions and services to a population experiencing homelessness, through a network of organizations that deliver services within a funding and policy context. He further states, however, that the system is not driven by specific legislation or theory. Instead of a coherent system, different approaches have been adopted by federal departments and the advocacy community. The authors assessment of progress and future opportunities focuses on the current emphasis on addressing chronic homelessness within the context of the proposed de facto system.

Changing Homeless and Mainstream Service Systems:  Essential Approaches to Ending Homelessness

Martha Burt and Brooke Spellman focus on how federal policy and state and local action have stimulated the development of homeless assistance networks and how those networks are evolving to address ending homelessness. While little formal research has been done on this subject, the authors present frameworks for assessing system change as well as describe promising practices from the field. They describe factors that may influence the success of change efforts, including the local and state context, the interest and commitment of stakeholders, the scope of desired change, the governance and management structure for change, and the intended process for change. They also review mechanisms that help make change happen by reorienting local continuums of care, matching clients and services, retooling funding approaches, and using data to track implementation and outcomes.

Consumer Integration and Self-Determination in Homelessness Research, Policy, Planning, and Services

Susan Barrow, Lorraine McMullin, Julia Tripp, and Sam Tsemberis assess how the process and outcomes of research, policy, and service delivery change when they involve or are driven by people who have themselves experienced homelessness. The authors review the available evaluation literature and present lessons from the field on consumer integration in research, policy, and program implementation. They also describe the barriers to consumer integration and strategies for addressing the barriers. They further address what happens when people who are homeless make the decisions about the housing and services they need. The authors review findings on the individual- and system-level impacts of consumer-driven approaches to homeless assistance.

People Who Experience Long-Term Homelessness: Characteristics and Interventions

Carol Caton, Carol Wilkins, and Jacquelyn Anderson document the considerable efforts of the past decade to address the needs of people who are considered chronically homeless; that is, unaccompanied adults with disabling conditions who experience long or numerous spells of homelessness. The authors detail the prevalence, characteristics, and service needs of adults who are chronically homeless and present a synthesis of recent research on service and housing interventions. Finally, they discuss the implications of the findings for services and for future research. The authors note that rigorous research on many interventions is lacking, but promising practices from the field may help guide the development of housing and services.

Homeless Families and Children

Debra Rog and John Buckner report that since the mid-1990s, there has been continued research and policy interest in understanding the characteristics and needs of families and children who become homeless, especially in understanding the heterogeneity within the population and whether a typology of families can be created (i.e., distinguishing families with greater needs for services and housing from those with lesser needs.) The authors review the findings from recent studies on homeless families and children and summarize the descriptive and outcome findings from evaluations of housing and service interventions and prevention efforts. With respect to children, research has focused on understanding and documenting the impact of homelessness on children. Rog and Buckner emphasize that that many of the challenges homeless families and children confront are also experienced by families that are very poor but not homeless, pointing to the need for further research on how to target assistance most efficiently to minimize the incidence and duration of homelessness for low-income families and children in general.

Homeless Youth in the United States:  Recent Research Findings and Intervention Approaches

Paul Toro, Amy Dworsky, and Patrick Fowler cite research indicating that youth may be the single age group most at risk of becoming homeless, yet comparatively little research has been done in the past decade on this vulnerable population. Some important progress has been made, including longitudinal studies on youth aging out of foster care. After reviewing the characteristics of homeless youth, the authors review recent research findings on the homeless youth population and interventions developed to address their housing and service needs. These include interventions directed at youth themselves (education, employment, social skills training) as well as family-focused strategies. The authors conclude with future directions for both research and practice.

Characteristics of Help-Seeking Street Youth and Non-Street Youth

Alma Molino, a graduate student in Clinical Psychology at Rosalind Franklin University of Medicine and Science, was selected through a competitive process to prepare a paper on her research on runaway and homeless youth. The author used data collected from callers to the National Runaway Switchboard to describe the characteristics and issues facing a large national sample of youth who have run away or are in crisis, and to examine the associations between these issues and status as a street youth (runaway, throwaway or homeless) or non-street youth (considering running away or being in general crisis). The relationship between the type and number of issues and the frequency of running behavior is also assessed.

Rural Homelessness

For the 1998 Symposium on Homelessness Research, rural homelessness was not assigned as a paper topic in its own right. Due to its increasing significance, Marjorie Robertson, Natalie Harris, Nancy Fritz, Rebecca Noftsinger, and Pamela Fischer prepared a paper on rural homelessness for the 2007 Symposium. Given the somewhat limited formal research available, the authors supplemented their literature review with information from government documents and technical assistance materials as well as input from an expert panel of researchers and practitioners. The paper summarizes what is documented to date about the characteristics of people who are homeless in rural areas and examines whether rural homelessness and the service approaches to address it can be differentiated from urban homelessness. The authors identify gaps in current knowledge about rural homelessness and recommend new directions for research.

Incarceration and Homelessness

Stephen Metraux, Caterina Roman, and Richard Cho provide a synthesis of the emerging literature on the nexus between incarceration and homelessness. The authors explain how the increasing numbers of people leaving carceral institutions face an increased risk for homelessness and, conversely, how persons experiencing homelessness are vulnerable to incarceration. The authors review recent efforts to address reentry issues and review research results on studies of homelessness among prison and jail populations and research on incarceration among people who homeless. After reviewing common barriers to housing for people who have been incarcerated, the authors assess what is known about the effectiveness of services and housing interventions to address these barriers and outline needs for future research.

Housing Models

Gretchen Locke, Jill Khadduri, and Ann OHara provide an overview of housing and service models for programs serving people who are homeless and synthesize the research on the efficacy of the models, what is known about what works for whom, and the implications for preventing and ending homelessness. The authors review how changes in income support and housing assistance programs in the past decade have contributed to greater competition for scarce resources for low-income households  both those that are homeless and those that are not. The authors then discuss findings from research and practice on housing and service intervention for families and for unaccompanied adults with disabilities. Noting the continued lack of rigorous research on program implementation as well as impacts, the paper concludes with suggestions for future research.

Employment and Income Supports for Homeless People

David Long, John Rio, and Jeremy Rosen synthesize the findings of recent studies examining the role of mainstream programs such as Supplemental Security Income (SSI), Social Security Disability Income (SSDI), Temporary Assistance for Needy Families (TANF), and Workforce Investment Act (WIA) initiatives in enhancing employment and incomes for people who have experienced homelessness. The authors also describe the design and outcomes of targeted programs designed specifically to address employment and income support for people who are homeless. While some rigorous evaluations have been done on mainstream programs, the effects of the interventions on the subpopulation that has been homeless are often not addressed. Few rigorous studies have been done on targeted programs. The authors draw several conclusions from the available evidence and outline future research directions to fill important gaps in the research literature.

Accountability, Cost-Effectiveness, and Program Performance:  Progress Since 1998

Dennis Culhane, Wayne Parker, Barbara Poppe, Kennen Gross, and Ezra Sykes summarize the progress made in the past decade toward making homeless assistance programs more accountable to funders, consumers, and the public. The authors observe that research on the costs of homelessness and cost offsets associated with intervention programs has been limited to people who are homeless with severe mental illness. But this research has raised awareness of the value of this approach, such that dozens of new studies in this area are underway, mostly focused on "chronic homelessness." Less progress has been made in using cost and performance data to systematically assess interventions for families, youth, and transitionally homeless adults. The authors present case studies of promising practices from the State of Arizona and Columbus, Ohio, demonstrating innovative uses of client and program data to measure performance and improve program management toward state policy goals, such as increased housing placement rates, reduced lengths of homelessness, and improved housing stability.