Ending Chronic Homelessness: Strategies for Action. Implications of the Findings

03/01/2003

The findings presented above represent a consolidation of statements, tabulations, or observations accumulated during several months of information seeking. Few of the findings are unique to any one service program; they tended to cover concerns and opportunities involving multiple programs and agencies. The next chapter briefly describes the processes used to distill the accumulated information and to develop recommendations for a comprehensive approach for the Department.

 

TABLE 1
HOMELESS-RELEVANT SERVICES AVAILABLE IN HHS ASSISTANCE PROGRAMS(a)
Services Provided —

HHS Mainstream Assistance Programs

CORE SERVICES   SUPPORTIVE SERVICES
Out-
reach
Primary Health Care Alcohol & Drug Abuse Services Mental Health & Counsel-
ing Services
In-
patient Services
Suppor-
tive Case Mgt
Intensive/
ACT Case Mgt
I & R Income Mgmt & Support Resi-
dential Treat-
ment
Dis-
charge Planning
No. of Core Services Offered Life Skills Child Care Educa-
tion & Train-
ing
Employ-
ment Services
Legal Trans-
portation
No. of Suppor-
tive Services Offered
Community Mental Health Services Block Grant (CMHSBG) X X X X   X X X X X X 10 X X X X X X 6
Community Services Block Grant (CSBG) X   X     X   X       4   X X X X X 5
Consolidated Community Health Centers (CHCs) (b) X(c) (d) (d) (b) (b)   X X(e)   X(f) 4     X(g)     X(h) 2
Medicaid k X(l) X(m) X(n) X(o) X X(p) X(q) X(r)   (s) X 9 X(t)     X(u)   X(v) 3
Ryan White Act X X X X   X X X X X X 10 X X X X X X 6
Social Service Block Grant (SSBG) X X X X   X X X   X   8 X X X X X X 6
Substance Abuse Prevention & Treatment Block Grant X   X     X X X   X X 7 X X       X 3
Temporary Assistance for Needy Families (TANF) X(w)   X(x) X(x)   X(w) X(w) X(w) X X(w) X(w) 10 X(w) X(w) X(w) X(w) X(w) X(w) 6
No. of Programs Offering Service 7 6 7 5 1 7 6 8 4 5 6   6 6 6 6 5 8  
Notes:
(a)  Services provided refers to those that are required, eligible or covered in each program.
(b)  A supplemental service available to some but not all centers.
(c)  In-home services not a requirement of the program.
(d)  Mental health service include services of a psychiatrist, psychologist, & other appropriate mental health professionals. These services are supplemental; most centers do not have extensive mental health services.
(e  Through referrals to other providers.
(f)  Patients are followed in the hospital either directly with privileges or through appropriate referral mechanisms.
(g)  Limited to health education
(h)  Transportation, as needed for adequate patient care. Residents of catchment area served by the Center with special difficulties of access to services provided by the Center may receive such services.
(I)  Outreach & engagement are required in Head Start, but are not specific to homeless persons.
(j)  Not used.
(k)  All provided Medicaid services are State administered and limited in amount, duration, and scope.
(l)  As administrative expense (50 percent match).
(m)  Physician, outpatient hospital, home health for persons eligible for nursing facility services, rural health clinic services, lab & x-ray, FQHC services. Eligible/covered include clinic, optometrist/eyeglasses, prescribed drugs, prosthetic devices, dental.
(n)  Eligibility requires meeting categorical requirements other than substance abuse.
(o)  If physician service or in-patient hospital. Eligible/covered: prescription drugs & additional services under a waiver program.
(p)  State option
(q)  Service may be created using State plan option(s).
(r)  May be part of case management services or service provided by managed care organizations.
(s)  If inpatient hospital, nursing facility, intermediate care facility for mental retardation, or psychiatric residential treatment facility for persons under 21 years of age.
(t)  Particularly under a waiver program.
(u)  Specialized therapies only (e.g., occupational, speech, & physical).
(v)  May be covered to receive medical care as program or administrative costs by a state.
(w)  State option, but families are the clients, not individuals.
(x)  Service must be non-medical in nature.

Endnotes

1.  General Accounting Office. "Homelessness: Coordination and Evaluation of Programs Are Essential." GAO/RCED-99-49. Wash, DC: 1999.

2.  HHS is responsible for five programs specifically targeted to homeless persons. Three of these were acknowledged in the GAO report:

  • Health Care for the Homeless, providing primary care services to homeless persons;
  • Runaway and Homeless Youth programs, providing street outreach, transitional living, and basic service centers for this population; and
  • Projects for Assistance in Transition from Homelessness, assisting States to provide a variety of services to homeless persons with serious psychiatric problems.

HHS is also responsible for a Federal Surplus Real Property program that transfers surplus Federal land and buildings to organizations that use it to provide homeless assistance. Since the latter program was not a direct service program, it was not included in the 1999 GAO study. Finally, in 2001, HHS added its newest targeted program: Cooperative Agreements for the Development of Comprehensive Drug and Alcohol Treatment for Systems for Homeless Persons, stressing service delivery to those with substance use problems. All of these programs emphasize service responses to homelessness and cumulatively report assisting more than 600,000 homeless persons annually. In this report, the emphasis was on the contribution the non-targeted HHS programs can make to reducing and ending chronic homelessness. The Department acknowledges the vital contributions the targeted programs are already making in addressing chronic homelessness and the de facto role they will play in a comprehensive approach.

3.  This is not meant to convey that other HHS assistance programs are not relevant or applicable to chronic homelessness. The selection of these eight was consistent with expectations established by the earlier GAO study and provided a diverse sample of HHS programs for consideration.

4.  Personal communication to W. Leginski from L. Hatton, May 2002.

5.  The authorization for some of these mainstream programs may restrict whether the Department can obtain specific data on homelessness. Only the Community Health Centers reported data for the service of primary health care, indicating that the service was provided to 80,000 homeless persons.

6.  "Eliminating the Silos" January 2002. The Midwest Welfare Peer Assistance Network: Madison, WI. p. 2.

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