2. Definitions WHAT DO WE LABEL “HOMELESS”?
The HUD Definition: Sheltered and Unsheltered Persons (street, cars, parks, etc.)
The Dept. of Education & Dept. of Agriculture Definition includes doubled-up households
Policy mandates explain the difference

3. Measurement THE NUMBERS DEBATE PIT vs. Annual Shelter Use
PIT Captures Unsheltered—imperfectly
Large variations in unsheltered rates create differing uncertainty
EX: LA 75% unsheltered, NYC 5% unsheltered
#s have been verified in 2016 AHAR Part 2
Source: 2016 AHAR Part 2

4. Why Variation in Unsheltered?
Historical factors affect social welfare effort (Cybelle Fox, 2012)
Northeast & Midwest: Early industrial wealth & European ethnic solidarity
South & Southwest: Agricultural economy & Black/Mexican workforce
Institutionalized federal preference with McKinney Vento
Some continued independent effect of weather

5. How Big is Homelessness?
1.42 million used an emergency shelter or transitional housing program in 2016
Most recent PIT—549,928
Of that 176,357 were unsheltered, half of the single adult population
More than 50% of unsheltered are in four states—California, Oregon, Hawaii, and Nevada
All numbers have been double-checked with the 2016 AHAR Part 2
Source: 2016 AHAR Part 2

6. Demographic Subgroups
INDIVIDUALS EXPERIENCING HOMELESSNESS ARE…
Twice as likely to be African American
2.5x as likely to be men (unsheltered homelessness)
1/3 in families; Among children, mostly pre-school age
Individuals experiencing sheltered homelessness were twice as likely to identify as African American as were individuals in the U.S. population living in poverty (38% versus 18.5%). Source—2016 AHAR Part 2
Men—70.3% of unsheltered are men—70.3/29.2 = 2.4. Meaning, men are 2.4 times more likely to experience unsheltered homelessness. (2016 AHAR Part 1--in 2017 Part 1 it’s 70.6% of unsheltered are men so we could change to 2.5 time as likely to be men)
Among children stat—confirmed in 2016 AHAR Part 2-- ”About three in five people in families experiencing sheltered homelessness (60.8%) were children under 18. About half of these children (49.6%) were under six years old, and 10.7 percent were infants less than one year old.”
Source: 2016 AHAR Part 2

7. Dynamics Patterns of exit and re-entry Predictors of exit and re-entry
A typology of homelessness
in wake of dynamics, lots of research focused on entry into homelessness w/ an eye on prevention. Why this is good but also problematic. Problematic--so many at risk and so few of at risk actually become homeless
one of features of dynamics is its focus on exits, how people get out of homelessness
Matthew Marr study on comparing Tokyo and LA exits from homelessness. Is whole idea of forgiving contexts. People get out bc of forgiving contexts. His model for exits is almost mirror image on multi-level causes of homelessness
Individuals risk factors literature--how it failed to predict who becomes, remains, and returns to homelessness
and O'Flaherty's insight--largely event-driven, random among at-risk pool

8. Cluster Distributions: Persons and Shelter Days Consumed Single Adults in Philadelphia (Kuhn & Culhane, 1998)
Crisis
1.19 stays
20.4 days
Episodic
3.84 stays
72.8 days
Chronic
1.53 stays
252.4 days

9. Background Characteristics by Cluster (Single Adults in Philadelphia)
Source: Kuhn & Culhane, 1998

10. Implications Crisis Homelessness: Prevention and relocation assistance
Episodic Homelessness: Low-demand residences (safe havens), harm reduction, step down housing
Chronic Homelessness: Permanent supportive housing

11. The New York/New York Evaluation

12. Mean Days Used (2-year pre-NY/NY)
Cost of Homelessness
Service Provider
Mean Days Used (2-year pre-NY/NY)
Per Diem Cost
Annualized
Cost
NYC DHS – Shelter
137
$68
$4,658
NYS OMH – Hospital
57.3
$437
$12,520
NYC HHC – Hospital
16.5
$755
$6,229
Medicaid – Hospital
35.3
$657
$11,596
Medicaid – Outpatient
62.2 (visits)
$84
$2,612
VA – Hospital
7.8
$467
$1,821
NYS DCJS – Prison
9.3
$79
$367
NYC DOC – Jail 10
$129
$645
Total
$40,449

13. NY/NY Cost Offsets: Per Housing Unit Per Year
Service
Annualized Savings per NY/NY Unit
DHS Shelter
$3,779
OMH Hospital
$8,260
HHC Hospital
$1,771
Medicaid – Inpatient
$3,787
Medicaid - Outpatient
($2,657)
VA Hospital
$595
NYS Prison
$418
NYC Jail
$328
Total
$16,282

14. NY/NY Housing: Costs & Cost Offsets

15. Key Findings
95% of supportive housing costs are offset by service reductions
Study underestimated savings associated with program-funded services (McKinney-Vento) and crime
Study did not quantify benefits to consumers
NY/NY was a sound public investment

16. What’s been done since NY NY?
Congress and Bush increased funding to $400 million annually from ; a 35% increase
60,000 units of PSH created
Congress and Obama increased funding to $1.2B annually for homeless veterans; a three-fold increase
88,000 VASH PSH units
150,000 HH annually in SSVF – VA’s Prevention & Rapid Rehousing program

17. Since then, we’ve learned…
Cost offsets are most achievable for high-cost users
High cost service use is highly intermittent—more research is needed to look at long time horizons
Dan Flaming-–developed predictive algorithm for high cost users
Ethical & actuarial issues remain

18. The Homeless Population is Aging
A Birth Cohort Phenomenon

19. A Birth Cohort Phenomenon: Persons Born 1955-1965
Age Distribution, Male Shelter Users, US Census
40-42
31-33
49-51
1 in 3 sheltered homeless single adult males was in 2010
(1 in 5 in 2000, 1 in 8 in 1990)
Age Curves from Census Data
Source: Culhane et al. (2013)/ U.S. Census Bureau Decennial Census Special Tabulation

20. Projected Elderly Population Increase in LA County
Age 50+
Age 65+

21. Is the Cohort Phenomenon Repeating?
Looking at descriptive measures of males staying in NYC single adult shelters (i.e., prevalence populations) for 1988, 1995, 2000, 2005, and 2010 suggests that shelter use among this population is largely a cohort‐related phenomenon. This is clearly represented in Figure 1, which shows the age distributions in each of these 5 years. 
Source: Culhane et al. (2013)/ New York City Department of Homeless Services Shelter Utilization Data

22. Age Distribution of all Adults in Shelter: 2014
13,980 people 30 or younger
in adult-only households

23. Homeless Families and Adults Experiencing Crisis Homelessness
Aren’t much different from housed peers:
Lower MH/SA rates
Relatively homogeneous
Prediction is poor among pool of at-risk
Is it a stochastic process? Event driven? (O’ Flaherty, 2010)

24. Model Cost by Volume Service System for Addressing Housing Emergencies
Shelter Admission
Diversion,
Relocation and
Transitional Rental
Assistance
Volume
Prevention
Supportive
Housing
Cost per Case
Community-
Based programs
Mainstream systems

25. Veterans Have been able to take solutions to scale
SSVF—Prevention & Rapid Rehousing
VASH, PSH for chronically homeless
only place that this has been looked at to scale. Congress has put up close to 9 billion at this point. Have cut vet homelessness in half and could do so again in the next 2-3 years.

26. SSVF Rapid Rehousing: Returns to Homelessness
1 Year
Singles: 15.7%
Families: 10.1%
Insert slide showing decling in Vet homelessness after this slide. Should be one in the AHAR report 2016 Part 2

27. PIT Estimates of Homeless Veterans By Sheltered Status, 2009 - 2017
Source: 2017 AHAR, Part 1

28. There’s strong evidence that homelessness programs work
Overall, homelessness has been steadily declining for the last ten years
We continue to see success with families, veterans, and chronic homelessness
But West Coast homelessness continues to grow
Concluding remarks.

29. West Coast Homelessness
Emergence of encampments underlies growing pessimism
Zillow study showing rent price increases and vacancy rates as significant drivers (Glynn, 2017)
Growing the housing stock is a long-term strategy
Near-term efforts should focus on proven intermediate interventions
Concluding remarks.

30. Taking Solutions to Scale
Increased prevention (focused especially on institutions) = fewer entries
RRH = accelerated exits
PSH = reduced chronic homelessness
Scale will take resources--HI & Measure H?
Concluding remarks.

31. Q&A Unaddressed, but can be covered in the Q&A—
Unsheltered homelessness & its history
Sex offenders
Opiates