Practica[ Less~rbsc : The IQ98 National Symposium 0.6 Homeleqsness. Research U.S. Department of Housing and Urban Develqpmnet Office of Policy Development and Research U.S. Department of Health,.. and Human Services qffice of the Assistant Secretary for Planning and Evaluqtion Health Resources and Services Administration “‘. Substance Abuse and Mental FFalth Services qdmiqistrqtjon EDITEDBY: Ljnda B. Fosburg, Ph.D., Abt Associates Inc. Dkborah L. Dennis, M.A., Policy Research Associates, Inc. August 1999 FOREWORD Homelessness in America affects a diverse population: families with children, people with disabilities, and others who flee from domestic violence or simply lose a job and cannot afford decent housing. Despite substantially increased funding and attention by government agencies, nonprofit groups, and thousands of volunteers, homelessness is still too common. Much remains to be done. In the past few years, Federal, state and local agencies have created partnerships that use a comprehensive approach to the housing and support services needs of homeless adults and families with children. This new ‘continuum of care’ and other efforts to coordinate and integrate government and local services have successfully restructured service- delivery systems and improved our ability to respond to homelessness. There has been a wealth of research over the past decade on homeless issues, including the nature of homelessness and characteristics of the homeless population; the special needs of homeless persons with disabilities; critical support services and other assistance homeless people need to become more self-sufficient; and new approaches to the problem. This is a broad range of important topics, and it is appropriate to review these findings carefully. HHS and HUD collaborated to draw practical lessons from the studies. Leading researchers, program managers, practitioners and consumers commented on, reviewed, and synthesized knowledge about how to design continuums of care and how to provide services to homeless persons most effectively. As a result of this work, we have developed Practical Lessons: The 1998 Symposium on Homelessness Research, a set of summary papers and topics for fiuther examination. We are pleased to make this publication available to those concerned with and working to solve these problems, with the hope that it will help us all reach our goal of ending homelessness in America. Andrew Cuomo Donna S halala Secretary of Housing and Urban Development Secretary of Health and Human Services Table of Contents . Acknowledgements . 111 Overview . ................. V 1. Demographics and Geography: Estimating Needs . l-l By: Martha R. Burt, Ph.D 2. Special Populations of Homeless Americans . 2-l By: Robert Rosenheck, M.D., Ellen Bassuk, M.D., and Amy Salomon, Ph.D. 3. Homeless Youth: Research, Intervention, and Policy . 3-l By: Marjorie J. Robertson, Ph.D., and Paul A. Toro, Ph.D. 4. Making Homeless Programs Accountable to Consumers, Funders and the Public . ...4-1 By: Dennis Culhane, Ph.D., David Eldridge, M.S.W., Robert Rosenheck, M.D., and Carol Wilkins, M.P.P. 5. Giving Voice to Homeless People in Policy, Practice and Research . 5- 1 By: Nicole Glasser 6. To Dance With Grace: Outreach and Engagement to Persons on the Street . 6-l By: Sally Erickson, M.S.W. and Jaimie Page, M.S.W., L.S.W. 7. A Review of Case Management for People Who Are Homeless: Implications for Practice, Policy and Research . 7-l By: Gary Morse, Ph.D. 8. Balancing Act: Clinical Practices that Respond to the Needs of Homeless People . 8- I By: Marsha McMurray-Avila, M.C.R.P., Lillian Gelberg, M.D., M.S .P.H., and William R. Breakey, M.D. 9. Emergency Shelter and Services: Opening a Front Door to the Continuum of Care.........9-1 By: Judith D. Feins, Ph.D. and Linda B. Fosburg, Ph.D. 10. Transitional Housing and Services: A Synthesis . 10-l By: Sue Barrow, Ph.D. and Rita Zimmer, M.P.H. 1 1. Reconnecting Homeless Individuals and Families to the Community . 1 l-l By: Debra J. Rog, Ph.D. and C. Scott Holupka, Ph.D. National Symposium on Homelessness Research 1 I 12. What Do We Know About the Systems Integration and Homelessness? . 12-l By: Deborah L. Dennis, M.A., Joseph J. Cocozza, Ph.D., and Henry J. Steadman, Ph.D. 13. Rethinking the Prevention of Homelessness . 13-l By: Marybeth Shinn, Ph.D. and Jim Baumohl, D.S.W. Appendix A - Agenda . A- 1 Appendix B - Biographies . B-l Appendix C - Participant List .,.....................................................,............................................. C-l ._ ---- ii National Symposium on Homelessngss Research ,, Acknowledgements The editors of this report on the National Symposium on Homelessness Research: What Works-Linda B. Fosburg and Deborah L. Dennis- thank many others for their valuable assistance in planning, implementing, and reporting on the outcomes of the symposium. From the beginning in December 1997, this project has been a team effort that has benefited from the collaboration of many other persons. First, we recognize the invaluable contributions of two other core members of the planning team-James E. Hoben and Mary Ellen O’Connell-the representatives of the cosponsors of the symposium, the Department of Housing and Urban Development (HUD) and the Department of Health and Human Services (HHS). We, as the core planning team, also thank the other planning team members-George Ferguson, Jean Hochron, Walter Leginski and Marge Martin. Second, we thank the members of the expert panel who reviewed the initial plans and provided important input into the content and format of the symposium. Among those who participated in this activity were: Martha Burt (The Urban Institute), Mary Ann Gleason (National Coalition for the Homeless), Steven Hornburg (Fannie Mae Foundation), Paul Koegel (RAND Corporation), Betsey Lieberman (AIDS Housing of Washington), Ann O’Hara (Technical Assistance Collaborative), Marjorie Robertson (California Pacific Medical Center Research Institute), Debra Rog (Vanderbuilt University Institute for Public Policy Studies), Nan Roman (National Alliance to End Homelessness), Robert Rosenheck (West Haven Veterans Administration Medical Center), Amy Soloman (The Better Homes Fund), Julie Sandorf (Corporation for Supportive Housing), Laurel Weir (National Law Center for Homelessness and Poverty), and Beth Weitzman (New York University). Third, we are grateful for the contributions of the Federal representatives who opened and closed the symposium, including: Xavier de Souza Briggs (Deputy Assistant Secretary for Research, Evaluation, and Monitoring at HUD), Margaret Hamburg (Assistant Secretary for Planning and Evaluation at HHS), Fred Karnas, Jr. (Deputy Assistant Secretary for Economic Development, Office of Community Planning and Development at HUD), and Marsha Martin (Special Assistant to the.Secretary of HHS). We also thank all the facilitators at the symposium: Ann O’Hara did a wonderful job as the overall symposium facilitator; Linda Boone, James Hoben, Jean Hochron, Mark Johnston, Walter Leginski, Gretchen NOB, James O’Connell, Mary Ellen O’Connell, Fred Osher, Fran Randolph, Amy Soloman, and Jean Whaley provided the leadership for the facilitated discussions. We also acknowledge and thank Donald Bradley of the Freddie Mac Foundation for providing scholarships to allow formerly homeless persons to attend and for the reception at the end of the first day of the symposium. We give a special thanks to all of the authors of the research synthesis papers who provided the substance for symposium. We also thank respondents to each of the research papers. The names of the authors and respondents are shown in the agenda in Appendix A. We thank the staffs of Abt Associates Inc. and Policy Research Associates who assisted us in all aspects of this project. Finally, we recognize the contributions of all of the authors who have conducted the research on homelessness over the past two decades. Their efforts are listed in the bibliographies of each of the research synthesis papers. National Symposium on Homelessness Research 1 iii ._ Overview bY Linda B. Fosburg, Ph.D. Deborah L. Dennis, M.A. When passed in 1987, the Stewart B. McKinney Homeless Assistance Act (P. L. 100-77) was landmark legislation providing the first federal funds targeted specifically to address the needs of homeless persons. The McKinney Act originally consisted of fifteen programs providing a range of services to homeless people, including emergency shelter, transitional housing, primary health care, education, and some social service needs. By 1998, approximately one decade after the McKinney funds became available and research results on the impacts of funding were becoming available, it was appropriate to address the question-What works? The National Symposium on Homelessness Research was convened in Arlington, Virginia on October 29* and 30*, 1998 under the auspices of the U. S. Departments of Housing and Urban Development (HUD) and Health and Human Services (HHS) for this purpose. 1 Approximately 175 persons (including researchers, practitioners, policymakers, and formerly homeless persons) attended. During the two-day meeting, all in attendance had an opportunity to participate. Authors of eleven research papers presented their findings. Facilitated discussion groups followed the research presentations. Designated respondents provided prepared comments and other attendees gave additional feedback to the authors. Plenary discussions were another source of feedback to the authors and symposium planners.