There are at least three reasons why understanding who experiences chronic homelessness and what treatments and services are effective is relevant to the HHS programs designed to assist poor and disabled persons.
First, these mainstream programs are extremely likely to have had substantial contact with these individuals prior to their becoming chronically homeless. Research studies show that persons experiencing chronic homelessness have long and extensive histories of involvement with the publicly-funded treatment system before their period of long term homelessness. These service experiences seemingly did little to prevent their slide into a pattern of long term homelessness.
No mainstream program wants to waste an investment it has made in helping clients make gains. Falling out of treatment and into a pattern of long term homelessness represents a set back to gains the client experienced from treatment and services. In addition to concerns about the efficient use of resources, this experience may mean the person is wary of re-engaging with the types of providers that were not attentive to his or her risk of becoming homeless.
Second, their homeless status does not mean that chronically homeless persons are no longer using mainstream service resources. As noted above, they are heavy users of services, often expensive inpatient and emergency room services, unguided by a comprehensive treatment plan. Mainstream programs continue to absorb at least some of the costs for these expensive and ad hoc treatments.
Third, the levels of disability and poverty that characterize persons experiencing chronic homelessness make them likely to be eligible for a number of the HHS mainstream programs. The fact that they are unsheltered should not restrict them from benefitting from this assistance, but their homelessness often presents so many challenges that access to these benefits is not ideal. If HHS can craft approaches that improve their access to mainstream HHS service programs, contributing to a reduction in chronic homelessness, these same approaches should work for other eligible homeless individuals. These approaches might, thereby, provide solutions for addressing homelessness among families or youth.
HHS recognizes that the characteristics of chronic homelessness are primarily conceptual. They help to distinguish a population that presents service providers with unique demands and unique opportunities. The characteristics are an assortment of various problems and eligibility criteria that are relevant to many of the assistance programs supported by the Department. The characteristics reinforce the multiple treatment needs suggested in the earlier figure, but they do not have the rigor or uniqueness to suggest a singular eligibility group.
Instead, chronic homelessness — as a group of individuals with multiple service needs — overlaps with the types of beneficiaries and services of many of the HHS mainstream programs. This overlap suggests the appropriateness of response by the mainstream.
The access chronically homeless persons have to the mainstream programs and the ability of these programs to deliver the needed treatments and services consumed significant attention prior to the development of recommendations. The results of this examination are presented in the following chapter.
1. Institute of Medicine. Homelessness, Health, and Human Needs: Committee on Health Care for Homeless People. National Academy Press, Washington, DC, 1988
2. Metraux, Stephen, Dennis P. Culhane, Stacy Raphael, Matthew White, Carol Pearson, Eric Hirsch, Patricia Ferrell, Steve Rice, Barbara Ritter, & J. Stephen Cleghorn. "Assessing Homeless Population Size through the Use of Emergency and Transitional Shelter Services in 1998: Results from the Analysis of Administrative Data in Nine US Jurisdictions." Public Health Reports 2001; 116: 344-352.
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