Each year, approximately one percent of the U.S. population, some 2-3 million individuals, experiences a night of homelessness that puts them in contact with a homeless assistance provider, and at least 800,000 people are homeless in the United States on any given night (Burt et al 2001). Persons experiencing homelessness can benefit from the types of services supported by the programs offered by the U.S. Department of Health and Human Services (HHS). Among this population, there are several key subgroups, including:
- Chronically Homeless. Of the 2-3 million persons who experience homelessness annually, ten percent have been identified as chronically homeless due to their protracted spells of homelessness and the duration of their homelessness history. On any given night, this group will represent almost half of those who are homeless (Kuhn & Culhane 1998; Metraux et al. 2001). This subgroup has been identified as the long-term, or chronically homeless. HHS, the U.S. Department of Housing and Urban Development (HUD), the U.S Department of Veterans Affairs (VA) and the U.S. Interagency Council on Homelessness (USICH) have agreed on the following definition of chronically homeless: An unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or has had at least four episodes of homelessness in the past three years.
- Homeless Families. Data from the National Survey of Homeless Assistance Providers and Clients estimates that in 1998, families comprised 34 percent of the homeless population; 23 percent were children and 11 percent were adults in homeless families (Burt et al 1999). In a given year, this means 420,000 families, including 924,000 children, experience homelessness in the United States. For the purposes of this Plan, a homeless family is defined as one or two adults accompanied by at least one minor child who are either not housed or who have had recent periods during which they lacked housing.
- At-Risk Individuals. There are a number of other types of individuals who may be at-risk for becoming homeless or chronically homeless. For example, the annual prevalence of homelessness among adolescents is estimated at between 5.0 and 7.6 percent among youth aged 12 to 17, and evidence suggests that adolescents are the single age group most at risk for experiencing homelessness (Ringwalt, et al 1998; Robertson & Toro 1998). For the purposes of this Plan, homeless youth are defined as persons between the ages of 16-24 who do not have familial support and are unaccompanied living in shelters or on the street. Other vulnerable groups at-risk of homelessness include individuals with disabilities, immigrants, persons leaving institutions (e.g., incarceration, inpatient care for psychiatric or chronic medical conditions), youth aging out of foster care, frail elderly, persons experiencing abuse, and disaster victims.
The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and supporting the delivery of essential human services, especially for those who are least able to help themselves. The Department is the largest grant-making agency in the federal government, and the Medicare program alone is the nation's largest health insurer (http://www.hhs.gov/about/whatwedo.html). The programs and activities sponsored by the Department are administered by eleven operating divisions that work closely with state, local, and tribal governments. Many HHS-funded services are provided at the local level by state, county or tribal agencies, or through private sector and community and faith-based grantees.
HHS work in the area of homelessness fits well with the Departments mission and priorities. The principals that form the philosophical underpinnings of the Secretarys 500 Day Plan are applicable to persons experiencing homelessness, particularly the first principal which reads care for the truly needy, foster self-reliance. Additionally, the Department seeks to further the Presidents New Freedom Initiative to promote participation by all Americans with disabilities, including mental disabilities in their communities. One of the goals in the report of the Presidents New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America outlines the need for stable housing as a requirement for enabling individuals and families with mental illness to fully participate in their treatment and their communities. The Departments focus on homelessness is consistent with this recommendation.
Ending homelessness requires housing combined with the types of services supported by HHS programs. The delivery of treatment and services to persons experiencing homelessness are included in the activities of the Department, both in five programs specifically targeted to homeless individuals and in twelve non-targeted, or mainstream, service delivery programs (see Table 1 below). The targeted programs are much smaller in scope, but are designed specifically for individuals or families who are experiencing homelessness. Mainstream programs are designed to serve those who meet a set of eligibility criteria, which is often established by individual states, but are generally for use in serving low-income populations. Very often, persons experiencing homelessness may be eligible for services funded through these programs. Because the resources available for the mainstream programs are so much greater than the resources available for the targeted homeless programs, HHS has actively pursued an approach of increasing access to mainstream services for persons experiencing homelessness.
|Total Program Budget
FY 2006 (millions)
|Targeted Homeless Programs|
|Grants for the Benefit of Homeless Individuals (Treatment for Homeless)||44.0|
|Health Care for the Homeless||151.4|
|Projects for Assistance in Transition from Homelessness (PATH)||54.2|
|Programs for Runaway and Homeless Youth||102.8|
|Title V/Surplus Property*||--------|
|Access to Recovery||98.2|
|Child Support Enforcement Program||4,206.5|
|Community Mental Health Services Block Grant||428.0|
|Community Services Block Grant||630.0|
|Community Health Centers||1,785.0|
|Family Violence Prevention and Services Grant Program||127.6|
|Maternal and Child Health Services Block Grant||692.5|
|Ryan White CARE Act||2,036.3|
|Social Services Block Grant||1,700.0|
|State Childrens Health Insurance Program||5,451.0|
|Substance Abuse Prevention and Treatment Block Grant||1,757.4|
|Temporary Assistance for Needy Families||17,059.0|
|* The Title V/Surplus Property program involves the transfer of surplus federal property from HHS to a homeless assistance provider, and the program does not have a line item budget.|