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Homelessness: Programs and the People They Serve | Findings of the National Survey of Homeless Assistance Providers and Clients

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Document date: December 07, 1999
Released online: December 07, 1999


The nonpartisan Urban Institute publishes studies, reports, and books on timely topics worthy of public consideration. The views expressed are those of the authors and should not be attributed to the study's federal funders of to the Urban Institute, its trustees, or its funders.

This document is also available in PDF (922 KB), which many find useful for printing.

The Technical Report is available via the HUD website.



Contents

PREFACE
ACKNOWLEDGMENTS
HIGHLIGHTS
CHAPTER 1
CHAPTER 2
CHAPTER 3
CHAPTER 4
CHAPTER 5

1 Introduction and Design Overview

CHAPTER 1 HIGHLIGHTS

Introduction
Overview of the Study Design
Data Collection Approaches
Basic Analytic Categories
Defining Homelessness Status
Specifying Time Frames
Defining Family and Single Status
Defining Alcohol/Drug/Mental Health (ADM) Status
Describing Urban/Rural Location
Statistical Significance of Findings
Confidence Intervals
Statistical Significance of Comparisons
Risk of False Positives
Limitations of NSHAPC Findings
The Study Is Descriptive
The People in the Study Come from Homeless Assistance Programs
NSHAPC Was Designed to Collect Data on Clients Who Use Homeless Assistance Services
All Client Information Comes from the Clients Themselves
What the Study Does Not Do
The Structure of This Report
Additional Information May Be Found in the Technical Report

2 An Overview of Homeless Clients

CHAPTER 2 HIGHLIGHTS

Introduction
Demographic Characteristics of Homeless Clients
Sex
Race/Ethnicity
Age
Marital Status
Education
Veteran Status
The Children of Homeless Clients
Service Needs, Stresses, and Vulnerabilities
Service Needs as Seen by Clients
Food Consumption and Hunger
Victimization while Homeless
Physical Health Status and Insurance
Alcohol, Drug, and Mental Health Problems
History of Incarceration
Adverse Childhood Experiences
Where Homeless Clients Were Living
Characteristics of Clients Using Different Housing and Other Services
Income, Employment, and Other Income Sources
Income
Paid Employment
Receipt of Government Benefits
History of Homelessness
Clients Who Change Locations after Becoming Homeless
Comparisons of Clients from Central Cities, Suburbs, and Rural Areas
Comparisons with 1987 Urban Institute Findings

3 Comparing Currently with Formerly Homeless Clients and Other Service Users

CHAPTER 3 HIGHLIGHTS

Introduction
Basic Demographic Characteristics
Sex
Race/Ethnicity
Age
Education
Marital and Household Status
Veteran Status
Service Needs, Stresses, and Vulnerabilities
Service Needs as Seen by Clients
Food Consumption and Hunger
Physical Health Status and Insurance
Alcohol, Drug, and Mental Health Problems
Incarceration
Adverse Childhood Experiences
Income Levels, Sources, and Employment
History of Homelessness
Use of Homeless Assistance Programs
Lifetime Service Use
Urban/Rural Location

4 Homeless Assistance Programs

CHAPTER 4 HIGHLIGHTS

Introduction
Service Locations and Program Types
Service Level and Program Size
Total Number of Expected Service Contacts
Variability in Program Size
Operating Agencies
Funding Sources
Population Focus
Household Type
Special Population or Special Need
Occupancy Levels of Shelter/Housing Programs
Location of Homeless Assistance Programs
Availability of Services within NSHAPC's 76 Sampling Areas
Distribution of Program Contacts within Sampling Areas
Distribution of Services within Sampling Areas by Program Type
Distribution within Sampling Areas of Contacts with Different Types of Shelter/Housing Programs
5 Postscript

APPENDIX A: NSHAPC's PRIMARY SAMPLING AREAS
APPENDIX B: NSHAPC PROGRAM DEFINITIONS
REFERENCES


Figures and Tables

Figure 1.1 Sampling Areas for NSHAPC
Table 2.1 Demographic Characteristics of Homeless Clients, by Family Status
Figure 2.1 Sex of Homeless Clients and the U.S. Adult Population
Figure 2.2 Homeless Clients in Families
Figure 2.3 Race/Ethnicity of Homeless Clients and U.S. Adults
Figure 2.4 Age Distribution of Homeless Clients in Families, Single Homeless Clients, and U.S. Adults
Figure 2.5 Marital Status of Homeless Clients in Families, Single Homeless Clients, and All U.S. Adults
Figure 2.6 Educational Attainment of Homeless Clients in Families, Single Homeless Clients, and U.S. Adults
Table 2.2 Characteristics of Children under 18 Living with Homeless Parents, and the U.S. Population of Children
Table 2.3 Demographic Characteristics of Homeless Adults Plus Their Children Living with Them, Compared with the U.S. Population in Poverty and the General U.S. Population
Figure 2.7 Residence of Minor Children Who Do Not Live with a Homeless Parent
Figure 2.8 Most Important Thing Respondent Thinks Is Preventing Exit from Homelessness
Figure 2.9 Frequency of Food Problems in the Past 30 Days among Homeless Clients
Figure 2.10 Victimization of Clients while Homeless
Table 2.4 Alcohol, Drug, and Mental Health (ADM) Problems among Homeless Clients
Figure 2.11 Alcohol, Drug, and Mental Health Problems of Homeless Clients in Different Time Periods
Figure 2.12 Adverse Experiences before Reaching Age 18
Figure 2.13 Where Homeless Clients Slept on Day of Interview and Previous Seven Days
Table 2.5 Demographic and Other Characteristics of Homeless Clients, by Street Location and Program Use in Past Week
Table 2.6 Economic and Other Characteristics of Homeless Clients, by Family Status
Figure 2.14 Receipt of Means-Tested Benefits during Past Month, by Family Status
Table 2.7 History of Homelessness and Transiency, by Family Status
Figure 2.15 Pattern of Homelessness, by Family Status
Table 2.8 Movers: Origins and Destinations
Table 2.9 Characteristics of Homeless Clients in Central Cities, Suburbs, and Rural Areas
Figure 2.16 Urban/Rural Location of Homeless Clients Compared with the Poor U.S. Population
Table 2.10 What Has Changed? Comparing Homeless Clients Found in Central City Shelters and Soup Kitchens in 1987 and 1996
Figure 3.1 Sex, by Homeless Status
Table 3.1 Basic Demographic Characteristics, by Homeless Status
Figure 3.2 Age, by Homeless Status
Table 3.2 Service Needs, by Homeless Status
Table 3.3 Food Consumption and Hunger, by Homeless Status
Table 3.4 Physical Health Status, by Homeless Status
Figure 3.3 Ability to See a Doctor or Nurse, by Homeless Status
Figure 3.4 Medical Insurance Coverage, by Homeless Status
Table 3.5 Mental Health and Substance Use Problems, by Homeless Status
Figure 3.5 Any Mental Health, Alcohol, and/or Drug Use Problems, by Homeless Status
Table 3.6 History of Incarceration, by Homeless Status
Table 3.7 Adverse Childhood Experiences, by Homeless Status
Figure 3.6 Adverse Experiences before Age 18, by Homeless Status
Figure 3.7 Out-of-Home Experiences before Age 18, by Homeless Status
Table 3.8 Income Levels, Income Sources, and Employment, by Homeless Status
Figure 3.8 Income Received in the Last 30 Days, by Homeless Status
Figure 3.9 Money/Benefits Received from Government Sources in the Last 30 Days, by Homeless Status
Table 3.9 Number and Length of Homeless Periods, by Homeless Status
Figure 3.10 Number of Times Homeless, by Homeless Status
Table 3.10 Use of Homelessness Assistance Programs, by Homeless Status
Table 3.11 Urban/Rural Location, by Homeless Status
Figure 4.1 Number of Homeless Assistance Programs in the United States, 1996
Figure 4.2 Number of Program Contacts Expected at Programs of Different Types on an Average Day in February 1996
Figure 4.3 Size of Homeless Assistance Programs
Figure 4.4 Proportion of Program Contacts Provided by Larger Programs
Figure 4.5 Types of Agencies That Operate Homeless Assistance Programs
Figure 4.6 Types of Agencies Operating Housing, Food, Health, and Other Programs
Figure 4.7 Program Reliance on Government Funding
Figure 4.8 Types of Households Served by Homeless Assistance Programs
Figure 4.9 Special Population Focus of Homeless Assistance Programs
Figure 4.10 Special Needs Focus of Homeless Assistance Programs
Table 4.1 Shelter/Housing Utilization and Information on Turnaways
Figure 4.11 Distribution of Programs Compared with Program Contacts among Communities of Different Types
Figure 4.12 Distribution of Program Contacts across Different Types of Communities
Table 4.2 Statistics for Program Contacts on an Average Day in February 1996 in Primary Sampling Areas
Figure 4.13 Program Contacts in a Primary Sampling Area by Overall Population, per 10,000 Population, and per 10,000 Living in Poverty
Figure 4.14 Program Contacts in a Primary Sampling Area, by Program Type
Figure 4.15 Rate of Housing/Shelter Program Contacts per 10,000 Poor People, by Type of Housing Program



Preface

The 1996 National Survey of Homeless Assistance Providers and Clients is a landmark study. It was designed to provide updated information about the providers of homeless assistance and the characteristics of homeless persons who use services. The survey is based on a statistical sample of 76 metropolitan and nonmetropolitan areas, including small cities and rural areas. Data for the survey were collected between October 1995 and November 1996.

The survey is a response to the fact that homelessness remains one of America's most complicated and important social issues. Chronic poverty, coupled with physical and other disabilities, have combined with rapid changes in society, the workplace, and local housing markets to make many people vulnerable to its effects. With the enactment of the Stewart B. McKinney Homeless Assistance Act of 1987, Congress recognized the need to supplement "mainstream" federally funded housing and human services programs with funding that was specifically targeted to assist homeless people. Over $11 billion in McKinney funds have been appropriated since then, and billions more have been provided through other federal, state, and local programs and benefits.

Those who provide assistance—the government agencies, the thousands of nonprofit organizations, and countless private individuals—have learned a great deal about effective ways to meet the needs of homeless people through improved supportive services, increased housing options and cooperative ventures among agencies providing assistance. Although substantial progress has been made in obtaining funding and learning about effective approaches, much more remains to be done.

Despite significant increases in funding, program administrators had to manage their programs without reliable national data on the characteristics of the people they were serving and the newly emerging networks of services and service providers. Indeed, the last national study was conducted by the Urban Institute in 1987. In 1991, federal agencies began initial planning for a new national survey to fill this gap.

The new survey was designed and funded by 12 federal agencies1 in a collaborative venture under the auspices of the Interagency Council on the Homeless, a working group of the White House Domestic Policy Council. The U.S. Bureau of the Census collected the data, and the Urban Institute analyzed it. A panel comprised of public interest groups, nationally recognized researchers, and other experts on issues related to homelessness reviewed and commented on the analysis plan and draft reports. All of the draft survey instruments were published in the Federal Register for public review and comment.

It is important to note that the survey was not designed to produce a national count of the number of homeless people, nor does it include information on client characteristics at the regional or local levels. The survey was designed to provide up-to-date information about the providers of assistance to homeless people, the characteristics of those who use services that focus on homeless people, and how this population has changed in metropolitan areas since 1987. The analyses of the provider data examine factors such as geographic level (e.g., national, central city, communities outside of central cities but still within metropolitan statistical areas, and rural areas), program type, and the types and levels of services delivered. The data received from service users includes, but is not limited to, such characteristics as age, race/ethnicity, sex, family status, history of homelessness, employment, education, veteran status, and use of services and benefits.

The information in this report is critical to discussions about effective public policy responses needed to break the cycle of homelessness. As such, it provides an important baseline and foundation for future assessments of the nature and extent of homelessness. It also provides a valuable overview that will improve our understanding of the characteristics of homeless people who use services, the nature of homelessness, and how best to address it.2



Acknowledgments

Many people played a role in bringing this report to fruition. James Hoben of the Department of Housing and Urban Development, Mary Ellen O'Connell of the Department of Health and Human Services, and George Ferguson of the Interagency Council on the Homeless spearheaded the efforts of a Federal Working Group under the auspices of the Interagency Council. They had the responsibility for supervising all phases of the study; their counsel has greatly improved the report's structure, focus, and readability.

Other members of the Federal Working Group who contributed ideas, comments, comparison data, and support include Katherine Meredith of the Office of Management and Budget; Nancy Gordon, Cynthia Taeuber, Annetta Smith, Denise Smith, Marjorie Corlett, Charles Alexander, Dave Hubble, and Steve Tourkin of the Bureau of the Census; Fred Karnas, Marge Martin, Mark Johnston, and Michael Roanhouse of the Department of Housing and Urban Development; Marsha Martin, Pete Delany, and Michael Shoag of the Department of Health and Human Services; Pete Dougherty, Scott Steins, Gay Koerber, and Josephine Hawkins of the Department of Veterans Affairs; Joanne Wiggins, James Parker, Robin Bouckris, Mari Margil, and Wei-min Wang of the Department of Education; Kate Hine, Gary Bickel, John Pentecost, and Amy Donoghue of the Department of Agriculture; John Heinberg and Raymond Higgins of the Department of Labor; Carol Coleman and Yolanda Jones of the Federal Emergency Management Agency; Patricia Betch, Cassandra Wilkins, Christine Garcia, and Paul Davies of the Social Security Administration; Patricia Rose of the Department of Energy; Betty Jackson of the Department of Transportation; and Molly Brostrom, Jeremy Ben Ami, and Mary Smith of the Domestic Policy Council. In addition, Sharon Fondelier, Dave Hornick, Tracy Mattingly, and other Census Bureau staff have remained polite and forthcoming under the provocation of what must have seemed like never'ending requests for additional data, additional interpretation of methods, additional reviews of draft method sections, and additional hand-holding.

We were also assisted greatly by a devoted panel of experts on research and policy related to homelessness. These included Dennis Culhane of the University of Pennsylvania, Michael L. Dennis of Chestnut Health Systems, Linda Fosburg of Abt Associates, Howard Goldman of the University of Maryland—Baltimore, Kim Hopper of the Nathan Kline Institute, Gerry Hotaling of the University of Massachusetts—Lowell, Paul Koegel of the RAND Corporation, Norweeta Milburn of Hofstra University, Nan Roman of the National Alliance to End Homelessness, Robert Rosenheck of the Department of Veterans Affairs' Northeast Program Evaluation Center, James Stronge of the College of William and Mary, Beverly Toomey of Ohio State University, Sue Watlov'Phillips of Elim Transitional Housing, Inc., Laurel Weir of the National Law Center on Homelessness and Poverty, and Beth Weitzman of New York University.

Finally, Martin Frankel and K.P. Srinath of Abt Associates and Fritz Scheuren, John Marcotte, and Douglas Wissoker of the Urban Institute assisted with weighting and other statistical issues.


Highlights

[top of page]

Study Purpose and Design

What is the purpose of the National Survey of Homeless Assistance Providers and Clients (NSHAPC)?

  • NSHAPC was conducted in 1996 to provide information on homeless assistance programs and the clients who use them to federal agencies responsible for administering homeless assistance programs and to other interested parties. The data are national in scope, and the survey is the first to gather, through one effort, a wide range of information relevant to the missions of the federal sponsors.
  • NSHAPC was not designed or conducted to produce a count or estimate of homeless persons.

How was NSHAPC conducted?

  • The Bureau of the Census conducted the study for 12 federal agencies.
  • NSHAPC selected a sample of 76 geographical areas to represent the entire United States, including
    • the 28 largest metropolitan statistical areas (MSAs);
    • 24 small and medium-sized MSAs randomly selected from the remaining MSAs; and
    • 24 groups of rural counties randomly selected from all rural counties.
  • Through telephone interviews and a mail survey, the study identified and gathered information about 16 types of homeless assistance programs:
    • emergency shelters
    • transitional housing programs
    • permanent housing programs for formerly homeless people
    • programs distributing vouchers for emergency accommodation
    • programs accepting vouchers in exchange for giving emergency accommodation
    • food pantries
    • soup kitchens
    • mobile food programs
    • physical health care programs
    • mental health care programs
    • alcohol/drug programs
    • HIV/AIDS programs
    • outreach programs
    • drop-in centers
    • migrant labor camps used to provide emergency shelter for homeless people
    • other programs
  • A client survey was conducted. for this survey, homeless assistance programs* were randomly selected to represent all such programs in each of the study's primary sampling areas. Then users of these programs (clients) were randomly selected and interviewed to learn about their characteristics, situation, and needs.

Who and what does the NSHAPC sample represent? How should the results be interpreted?

  • The findings represent
    • homeless assistance programs nationwide in 1996; and
    • homeless people and other users of these programs in 1996.
  • Representatives of 11,909 programs were actually interviewed. These programs in the NSHAPC sample represent an estimated 40,000 such programs nationwide.
  • 4,207 clients who use these programs were actually interviewed. They represent all of the clients who use such programs nationwide. Of these,
    • 54 percent were homeless at the time of their interview;
    • 22 percent had been homeless in the past but were not homeless at the time of the interview; and
    • the remaining 24 percent were other service users who had never been homeless.
  • All information based on NSHAPC data are estimates. In general, percentages reported have a margin of error no greater than 4 percentage points.

Homeless Families

What proportion of homeless clients are in family households?

  • Each homeless client is an adult representing a homeless household.
  • 15 percent of these are family households (that is, the clients have one or more of their own children under age 18 with them).
  • On average, each homeless family household includes 2.2 minor children of the client.

If we include the children as part of the total, what proportion of all homeless service users are members of homeless families?

  • 34 percent of homeless service users are members of homeless families.
  • 23 percent are minor children and 11 percent are their parents.

What are the basic characteristics of the parent-clients in homeless families?

  • 84 percent are female and 16 percent are male.
  • 38 percent are white non-Hispanic, 43 percent are black non-Hispanic, 15 percent are Hispanic, 3 percent are Native American, and 1 percent are other races.
  • 26 percent are ages 17 to 24, 74 percent are ages 25 to 54, and less than 0.5 percent are ages 55 and older.
  • 41 percent have never married, 23 percent are married, 23 percent are separated, 13 percent are divorced, and none are widowed.
  • 53 percent have less than a high school education, 21 percent have completed high school, and 27 percent have some education beyond high school.

Single Homeless Clients

What are the basic characteristics of single homeless clients?

  • Most homeless clients (85 percent) are single (that is, they do not have any of their children with them).
  • 77 percent are male and 23 percent are female.
  • 41 percent are white non-Hispanic, 40 percent are black non-Hispanic, 10 percent are Hispanic, 8 percent are Native American, and 1 percent are other races.
  • 10 percent are ages 17 to 24, 81 percent are ages 25 to 54, and 9 percent are ages 55 and older.
  • 50 percent have never married, 7 percent are married, 14 percent are separated, 26 percent are divorced, and 4 percent are widowed.
  • 37 percent have less than a high school education, 36 percent have completed high school, and 28 percent have some education beyond high school.

Problems

Do homeless clients get enough to eat?

  • 28 percent say they sometimes or often do not get enough to eat, compared with 12 percent of poor American adults.
  • 20 percent eat one meal a day or less.
  • 39 percent say that in the last 30 days they were hungry but could not afford food to eat, compared with 5 percent of poor Americans.
  • 40 percent went one or more days in the last 30 days without anything to eat because they could not afford food, compared with 3 percent of poor Americans.

What proportion have problems with alcohol, drugs, or mental health?

Within the past month:

  • 38 percent report indicators of alcohol use problems.
  • 26 percent report indicators of drug use problems.
  • 39 percent report indicators of mental health problems.
  • 66 percent report indicators of one or more of these problems.

What proportion have physical health problems? What types of problems do they have?

At the time of the interview:

  • 3 percent report having HIV/AIDS.
  • 3 percent report having tuberculosis.
  • 26 percent report having acute infectious conditions, such as a cough, cold, bronchitis, pneumonia, tuberculosis, or sexually transmitted diseases other than AIDS.
  • 8 percent report having acute noninfectious conditions, such as skin ulcers, lice, or scabies.
  • 46 percent report having chronic health conditions, such as arthritis, high blood pressure, diabetes, or cancer.
  • 55 percent have no medical insurance.

What proportion experience victimization or violence while homeless?

While they have been homeless:

  • 38 percent say someone stole money or things directly from them.
  • 41 percent say someone stole money or things from their possessions while they were not present.
  • 22 percent have been physically assaulted.
  • 7 percent have been sexually assaulted.

How poor are homeless clients?

  • Single homeless clients report a mean income of $348 during the last 30 days. This amount is only 51 percent of the 1996 federal poverty level of $680/month for one person.
  • Clients in family households report a mean income of $475 during the last 30 days. This amount is only 46 percent of the 1996 federal poverty level of $1,023/month for a family of three.
  • Single homeless clients received only 12 percent of the median monthly income of all American households in 1995 ($2,840) in the month before being interviewed, and homeless families received only 17 percent.

Sources of Income and Benefits

How many homeless clients did any paid work in the past month?

  • 44 percent did paid work during the past month. Of these:
    • 20 percent worked in a job lasting or expected to last at least three months.
    • 25 percent worked at a temporary or day labor job.
    • 2 percent earned money by peddling or selling personal belongings.
  • 3 percent report more than one source of earned income.

How many receive income from family or friends?

  • 21 percent receive income from family members or friends, including:
    • 9 percent from parents.
    • 2 percent from a spouse.
    • 5 percent from other relatives.
    • 12 percent from friends, including boyfriends and girlfriends.
    • 1 percent from child support.
  • 8 percent report income from more than one type of family member or friend.

How many homeless clients receive government benefits?
What types of benefits?

  • 37 percent receive food stamps.
  • 52 percent of homeless households with children receive Aid to Families with Dependent Children (AFDC). (In 1996, when the survey was conducted, AFDC was still operating.)
  • 11 percent receive Supplemental Security Income (SSI).
  • 9 percent receive General Assistance or another state or local cash assistance benefit.
  • 6 percent of homeless veterans receive veteran-related disability payments; 2 percent receive veteran-related pensions.
  • 30 percent receive Medicaid, and another 7 percent receive medical care from the Department of Veterans Affairs.

How many homeless clients receive money from panhandling?

  • 8 percent report income from panhandling in the last 30 days.

The Location of Homeless Clients

In what types of communities (big cities, suburbs, and rural areas) are homeless clients found?

  • There are homeless clients in every type of community. The majority of homeless clients, 71 percent, are in central cities, while 21 percent are in the suburbs and urban fringe areas, and 9 percent are in rural areas. These figures contrast with the distribution of 31, 46, and 23 percent, respectively, for poor people in the United States.

How much do homeless clients move from one community to another?

  • 29 percent of homeless families and 46 percent of single homeless clients are not living in the same city or town where they became homeless.
  • Major reasons given for leaving the city or town where they first became homeless are the lack of jobs, the lack of affordable housing, and being evicted from or asked to leave the place where they were living.
  • Major reasons for coming to the city or town where they were interviewed are the presence of relatives or friends, the possibility of work, and the availability of shelters, missions, and other services.

Within their communities, where can homeless clients be found? What services do they use?

  • 31 percent slept on the streets or in other places not meant for habitation within the last week.
  • 66 percent used an emergency shelter, transitional housing program, or program offering vouchers for emergency accommodation within the last week.
  • 36 percent used soup kitchens within the last week.
  • 10 percent used other homeless assistance programs (e.g., drop-in centers, food pantries, outreach programs, mobile food programs) within the last week.

Patterns of Homelessness

How many people are homeless for the first time? How long are people homeless?

  • 49 percent of homeless clients are in their first episode of homelessness, while 34 percent have been homeless three or more times. Clients in families and single homeless clients are equally likely to be in their first homeless episode, but single clients are more likely than clients in families to have been homeless three times or more (37 versus 23 percent).
  • For 28 percent of homeless clients, their current episode has lasted three months or less, but for 30 percent it has lasted more than two years. Clients in families are more than twice as likely as single clients to have been homeless for three months or less (49 versus 23 percent), while single clients are almost three times as likely as clients in families to be in homeless spells that have lasted more than two years (34 versus 13 percent).

Other Important Profiles

How many homeless clients are parents? Are their children with them?

  • 60 percent of homeless women have children ages 0 to 17; 65 percent of these women live with at least one of their minor children.
  • 41 percent of homeless men have children ages 0 to 17; 7 percent of these men live with at least one of their minor children.

What are the characteristics of the children of homeless clients?

  • 53 percent of the children accompanying a homeless parent in this study are male and 47 percent are female.
  • Most of these children are young: 20 percent are ages 0 to 2, 22 percent are ages 3 to 5, 20 percent are ages 6 to 8, 33 percent are between the ages of 9 and 17, and age was not given for 5 percent.
  • Parents report that 45 percent of the 3- to 5-year-olds attend preschool, and that 93 percent of school-age children (ages 6 to 17) attend school regularly.
  • 51 percent of children are in households receiving AFDC, 70 percent are in households receiving food stamps, 12 percent are in households receiving SSI, and 73 percent receive Medicaid.

How many homeless clients are veterans? What is the proportion for homeless men?

  • 23 percent of homeless clients are veterans, compared with about 13 percent of all American adults in 1996.
  • 98 percent of homeless clients who are veterans are men. 33 percent of male homeless clients are veterans, as were 31 percent of American men in 1996.
  • 21 percent served before the Vietnam era (before August 1964); 47 percent served during the Vietnam era (between August 1964 and April 1975); and 57 percent served since the Vietnam era (after April 1975). Many have served in more than one time period.
  • 33 percent of the male veterans in the study were stationed in a war zone, and 28 percent were exposed to combat.

What adverse childhood experiences did homeless clients report?

  • 27 percent of homeless clients lived in foster care, a group home, or other institutional setting for part of their childhood.
  • 25 percent report childhood physical or sexual abuse.
  • 21 percent report childhood experiences of homelessness.
  • 33 percent report running away from home and 22 percent report being forced to leave home.

Homeless Assistance Programs

How many homeless assistance programs are there in the United States? What kinds of programs are they?

  • This study estimates that there are about 40,000 homeless assistance programs in the United States, offered at an estimated 21,000 service locations.
  • Food pantries are the most numerous type of program, estimated to number 9,000 programs. Emergency shelters are next with an estimated 5,700 programs, followed closely by transitional housing programs (4,400), soup kitchens and other distributors of prepared meals (3,500), outreach programs (3,300), and voucher distribution programs (3,100).
  • Emergency shelters expected 240,000 program contacts, transitional housing programs expected 160,000, permanent housing programs expected 110,00, and voucher distribution programs expected 70,000 program contacts on an average day in February 1996. Expected contacts include those made by both homeless and other people who use services.
  • 49 percent of all homeless assistance programs are located in central cities, 32 percent in rural areas, and 19 percent in suburban areas. However, because central city programs serve more clients, a larger share of program contacts happen in central cities (57 percent) than in suburban and rural areas (20 and 23 percent of all program contacts, respectively).
  • Great variation was found among the 76 sampling areas in their level of expected program contacts on an average day in February 1996.
    • The average estimated rate of program contacts per 10,000 poor people in a sampling area is 1,437, with a high of 9,000 and a low of 0. The biggest cities are providing about equal levels of service in relation to their poor population. Small and medium-sized metropolitan areas and rural areas reveal much more variability in service levels.

Changes between 1987 and 1996

What comparisons are possible between NSHAPC data and the last national study, conducted in 1987 by the Urban Institute (Burt and Cohen 1989)?

  • The 1987 study included only shelters and soup kitchens in large U.S. cities (those with 100,000 or more population), therefore the 1996 statistics used for this comparison use only homeless NSHAPC clients found in central cities who were sampled from emergency shelters, transitional housing programs, voucher distribution programs, and soup kitchens.

How do homeless shelter and soup kitchen clients located in central cities in 1996 compare to those in 1987?

  • They are less likely to be white (39 versus 46 percent) and more likely to be black (46 versus 41 percent).
  • They are better educated (more likely to have completed high school—39 versus 32 percent, and to have some education beyond high school—27 versus 20 percent).
  • More have never married (51 versus 45 percent), but have the same likelihood of living in family households (10 percent in each year).
  • They are much more likely to get government benefits: AFDC among homeless families with children—58 percent in 1996 versus 33 percent in 1987; food stamps among all homeless—38 versus 18 percent; SSI among all homeless—13 versus 4 percent.
  • They have higher average monthly incomes per capita after adjusting for inflation ($267 in 1996 versus $189 in 1987), but are still very poor.
  • They are less likely to say they sometimes or often do not get enough to eat—28 percent versus 38 percent; and more likely to say they get enough of what they want to eat—31 percent versus 19 percent.
  • No differences were found in the proportion experiencing inpatient treatment for alcohol or drug abuse, or for mental health problems.

Questions this Report Does Not Answer

  • How many homeless people are there? How many homeless people are there in my city/county/state?
  • What are the characteristics of homeless people in my city/county/state?
  • What factors cause homelessness?
  • What programs work best?

What If You Want to Know More?

Homelessness: Programs and the People They Serve—Summary Report contains more detailed information relevant to the questions posed in these highlights, as well as many other issues. Readers who want an even more detailed look at study results, or those who want to know more about its methodology, should consult Homelessness: Programs and the People They Serve—Technical Report. Two other items related to the survey are currently available. Lists containing the names, addresses, and telephone numbers of the homeless assistance providers in each of the 76 survey areas are available from the Interagency Council on the Homeless, HUD, 451 7th Street, SW, Room 7274, Washington, D.C. 20410, or by emailing
survey_results@hud.govsurvey_results@hud.gov.
Public use data files on CD may be purchased from Census Bureau Customer Service; call (301) 457'4100. Files are also available for downloading: go to http://www.census.gov and then click on "N" under the alphabetical listings "A-Z."


1 Introduction and Design Overview


HIGHLIGHTS

NSHAPC Methods Highlights
  • The National Survey of Homeless Assistance Providers and Clients (NSHAPC) was conducted to provide information about the providers of homeless assistance services and the characteristics of homeless clients who use these services for use by federal agencies responsible for administering homeless assistance programs and other interested parties. The data are national in scope, and the survey is the first to gather, through one effort, a wide range of information relevant to the missions of the federal sponsors. NSHAPC was not designed or conducted to produce a count or estimate of the number of homeless persons.
  • NSHAPC is based on a statistical sample designed to represent the entire United States. The sample includes 76 primary sampling areas: the country's 28 largest metropolitan statistical areas (MSAs), another 24 randomly sampled small and medium-sized MSAs, and 24 randomly sampled groups of rural counties.
  • NSHAPC involved two major phases: surveying administrators of homeless assistance programs through telephone interviews and mail surveys, and conducting face-to-face interviews with the clients of these programs.
  • Telephone interviews were conducted with representatives of about 6,400 service locations operating about 12,000 programs. This was followed by a mail survey of about 6,500 programs identified through the telephone interviews. Finally, to reach clients the study randomly selected programs within the primary sampling areas, and from these programs randomly selected about 4,200 program clients who completed in-person interviews.
  • NSHAPC covers 16 types of homeless assistance programs: emergency shelters, transitional housing, permanent housing for the formerly homeless, programs offering vouchers for temporary housing, programs accepting vouchers for temporary housing, food pantries (in rural areas), soup kitchens/meal distribution programs, mobile food programs, physical health care programs, mental health care programs, alcohol/drug programs, HIV/AIDS programs, outreach programs, drop-in centers, migrant housing used for homeless people, and other programs.
  • This study interviewed a random sample of clients who use homeless assistance programs.* Many were not homeless at the time of the interview. Some had been homeless at some earlier point in their lives, while others had never been homeless. In addition, although NSHAPC is nationally representative, it does not represent homeless people who do not use services or those in communities that have few or no homeless assistance services. These areas may have homeless people but because the NSHAPC sample is service based, they would not be included in this survey.
  • All numbers and simple percentages presented in the text have a 90 percent confidence interval (margin of error) less than or equal to 4 percentage points unless otherwise noted. All comparisons presented in the text are statistically significant at a 90 percent level or better (p less than or equal to .10).
  • This report does not answer several frequently asked questions, including: How many homeless people are there? How many homeless people are there in my city/county/state? What are the characteristics of homeless people in my city/county/state? What programs work best?


Introduction

Homelessness has been a constant presence in American cities, towns, and rural areas for many years, although during the recession of 1981-82 it was identified as a national issue for the first time since the Great Depression. Since the early 1980s, homelessness has been a regular focus of media interest and a topic of policy debate. The array of programs and services for homeless persons has increased greatly during this period, as has the funding needed to support them.

Reliable and comprehensive information about homeless clients has not been easy to obtain at the national level. In 1987 the Urban Institute conducted the first national study to interview homeless clients at some depth on a variety of topics. The data from that study were collected before the passage of the Stewart B. McKinney Homeless Assistance Act of 1987, and before the significant increase in federal involvement and program development that followed. Further, although national in scope, the Urban Institute study only went to central cities and collected data only from shelter and soup kitchen users, so it could not be used to characterize homelessness in the entire United States.

Nine years later, the National Survey of Homeless Assistance Providers and Clients (NSHAPC) was conducted to remedy this serious gap in knowledge. It became the second probability-based interview study on homelessness to be national in scope. This time, homeless clients in smaller cities, suburbs, and rural areas were included for a full picture of homeless service users in late 1996. NSHAPC thus provides the first opportunity since 1987 to update the national picture of homelessness in a comprehensive and reliable way. Occurring as it did before implementation of major changes in welfare programs, it also provides a baseline for the effects of welfare reform on homeless assistance programs.

NSHAPC was conceived, developed, and funded by 12 federal agencies under the auspices of the Interagency Council on the Homeless, a working group of the White House Domestic Policy Council.1 The Census Bureau carried out the data collection on behalf of the sponsoring agencies. This chapter presents findings related to the characteristics and experiences of homeless clients. Where possible, data on homeless clients are compared to statistics for the population of all American adults or those living in poverty, to provide readers with some context.

Overview of the Study2

The NSHAPC study was designed to provide a nationally representative sample of homeless and other clients who use homeless assistance programs, and of the programs themselves (exhibit 1.1). There were 76 primary sampling areas3 (figure 1.1), including

  • the 28 largest metropolitan statistical areas in the United States;
  • 24 small and medium-sized metropolitan statistical areas, selected at random to be representative of geographical regions (northeast, south, midwest, west) and size; and
  • 24 rural areas (groups of counties), selected at random from a sampling frame defined as the catchment areas of Community Action agencies, and representative of geographical regions. In New England, the actual areas sampled were parts of counties.

The study began by identifying and collecting information about all of the programs within each of the 76 primary sampling areas that met its definition of a homeless assistance program. Such programs had to have a focus on serving homeless people (although they did not have to serve homeless clients exclusively). They also had to offer direct service, and be within the geographical boundaries of the sampling area. In rural areas the study's definition of a program was expanded to include programs that served homeless people but may not have had this population as a focus. Sixteen types of homeless assistance programs were defined (exhibit 1.1).4

Figure 1.1

Data Collection Approaches

The study collected information in three ways:

Homeless assistance programs—basic description

  • Telephone interviews with representatives of 6,307 service locations offering 11,983 homeless assistance programs
    • A service location is the physical location at which one or more programs operate. A homeless assistance program is a set of services offered to the same group of clients at a single location and focused on serving homeless people as an intended population (although not always the only population).
    • Program directors or other staff knowledgeable about the program(s) offered at a particular location were interviewed by telephone. Basic descriptions of all homeless assistance programs offered at that location were obtained.

Homeless assistance programs—detailed information about services

  • Mail surveys from 5,694 programs
    • Surveys were completed by a staff person who knew the program and its clients well. Detailed information was collected about client needs, the extent to which these needs were met, and whether services to meet these needs were available at their own program or other programs in the community.
    • A service is any good or activity offered to clients using a program, but not qualifying on its own as a program.

Clients of homeless assistance programs

  • Interviews with 4,207 clients
    • A client is someone who uses a program, whether he or she is homeless or not. Interviews were conducted with clients of any age as long as they were not accompanied by a parent or guardian.
    • In each sampling area, the study selected a sample of the programs identified through the telephone interviews, taking into consideration program type and program size. Six to eight clients were interviewed at each of approximately 700 program visits. Census Bureau staff worked with the programs selected to establish the best times and methods to select and interview clients, and methods to pay clients once interviews were completed.
    • Six to eight people were selected randomly from among all clients using the program at the time of data collection. They were interviewed in person by trained interviewers from the Census Bureau. Most interviews took place at the program location. Clients selected through outreach programs or programs operating in the evening or at night were sometimes interviewed the next day at locations arranged in advance. Every effort was made to assure privacy during the interview. Clients completing the interview received $10 for their time.
Exhibit 1.1 Overview of NSHAPC Study Design
National Sample Based on:
  • 28 largest metropolitan statistical areas (MSAs)
  • 24 MSAs randomly sampled from the remaining small and medium-sized MSAs
  • 24 randomly sampled groups of rural counties
Definitions
  • Service location: a physical location at which one or more homeless assistance programs operate
  • Program: any one of the 16 types of programs eligible for inclusion in NSHAPC:
    1. emergency shelters
    2. transitional shelters/housing
    3. permanent housing for formerly homeless people
    4. programs offering vouchers for emergency accommodation
    5. programs accepting vouchers for emergency accommodation
    6. food pantries
    7. soup kitchens/meal distribution programs
    8. mobile food programs
    9. physical health care programs
    10. mental health care programs
    11. alcohol/drug programs
    12. HIV/AIDS programs
    13. outreach programs
    14. drop-in centers
    15. migrant housing used for homeless people
    16. other programs
  • Service: goods or activities offered to program clients
  • Client: anyone who uses a program and is not accompanied by a parent
Data Collection Techniques
  • Telephone interviews with representatives of all service locations identified in the sampled geographic areas (final unweighted sample of 6,307 service locations and the 11,983 programs they report offering)
  • Mail survey of programs reported during the telephone interviews (final unweighted sample of 5,694 programs)
  • Client interviews in a sample of programs in each of the sampled geographic areas (final unweighted sample of 4,207)

Basic Analytic Categories

Three important client subgroups are used throughout this report and need to be defined for the reader. These are homelessness status, family status, and alcohol/drug/mental health (ADM) status. Also described is the geographic basis for the terms "central city," "suburbs/urban fringe," and "rural," and the time frames used in the report.

Defining Homelessness Status

The study adopted the same definition of "homeless" as that used in the Stewart B. McKinney Homeless Assistance Act of 1987, namely an individual who lacks a fixed, regular, and adequate nighttime residence, or an individual who has a primary nighttime residence that is: (a) a supervised publicly or privately operated shelter designed to provide temporary living accommodations (including welfare hotels, congregate shelters, and transitional housing for the mentally ill); (b) a public or private place that provides a temporary residence for individuals intended to be institutionalized; or (c) a public or private place not designed for, or ordinarily used as, regular sleeping accommodations for human beings.

The following specific conditions were used to classify NSHAPC clients as currently homeless:

  • The clients reported staying in any of the following places on the day of the survey or during the seven-day period prior to being interviewed for NSHAPC:
    1. an emergency shelter or transitional housing program, or
    2. a hotel or motel paid for by a shelter voucher, or
    3. an abandoned building, a place of business, a car or other vehicle, or anywhere outside.
  • Or the clients
    1. reported that the last time they had "a place of [their] own for 30 days or more in the same place" was more than seven days ago, or
    2. said their last period of homelessness ended within the last seven days, or
    3. were selected for inclusion in the NSHAPC client survey at an emergency shelter, transitional housing program, or
    4. reported getting food from "the shelter where you live" within the last seven days, or
    5. on the day of the interview, said they stayed in their own or someone else's place but that they "could not sleep there for the next month without being asked to leave."

Use of the first criterion (shelter use) classifies 34.9 percent of the sample as currently homeless. Criteria (voucher use) and three (places not meant for habitation) add 1.7 percent and 9.8 percent, respectively, for a total of 46.4 percent. The five remaining criteria together add another 7.1 percent, for a final total of 53.5 percent of the sample classified as currently homeless. All but the final criterion meet the McKinney Act definition of homelessness; the last criterion adds only 0.3 percentage points to the final proportion classified as currently homeless, and was included because the survey itself treats clients in this situation as homeless.

Many clients who were not literally homeless reported having been homeless at some earlier time in their lives (22 percent of the full sample). The circumstances used to classify clients as formerly homeless also meet the McKinney Act definition of homelessness. Clients were classified as formerly homeless if they

  • did not meet any of the conditions qualifying them as currently homeless but at some point in their lives had stayed in any of the following:
    1. an emergency or transitional shelter, or
    2. a welfare/voucher hotel, or
    3. an abandoned building, a place of business, a car/other vehicle, or anywhere outside, or
    4. a permanent housing program for the formerly homeless; or
  • said they had previously had a period when they were homeless.

The remaining 24 percent of NSHAPC clients had never been homeless according to the criteria used here, and also said they had never been homeless. They are referred to throughout this report as other service users.

Specifying Time Frames

All time periods discussed in this report relate to the day a client was interviewed for the study (between October 18 and November 14, 1996). Thus, "past week" or "past seven days" refers to the week before the interview; "past month" or "past 30 days" refers to the month before the interview; and "past year" refers to the year before the interview. "Lifetime"refers to the client's life up to the time of the interview.

Defining Family and Single Status

In this report, a client is considered to be in a family household if she or he lives with one or more of his or her own children under age 18. For the sake of simplicity throughout the report, these clients will be referred to as "clients in families." It is not possible to determine who else might be members of these family households, nor is it possible to say with certainty that a respondent is alone. However, for simplicity of language, the family status variable reported throughout this study classifies clients into two mutually exclusive groups: clients in families and single clients.

Defining Alcohol/Drug/Mental Health (ADM) Status

In general, individuals are classified as having an ADM problem if they have had at least one alcohol use, drug use, or mental health problem during the past month. Presence of each problem was defined as follows.

Clients were classified as having a past month alcohol use problem if any of the following conditions were met: (1) they scored 0.17 or higher on a modified Addiction Severity Index5 (ASI) measure, (2) they reported drinking to get drunk three or more times a week within the past month, (3) they reported being treated for alcohol abuse within the past month, or (4) they reported ever having been treated for alcohol abuse and drinking three or more times a week within the past month.

Clients were classified as having a past year alcohol use problem if they met these same criteria within the past year (including the past month), and as having a lifetime alcohol use problem if they met these same criteria in their lifetime or if they reported ever having had three or more alcohol-related problems (such as blackouts, tremors, and/or convulsions).

Clients were classified as having a past month drug use problem if any of the following conditions were met: (1) they scored 0.10 or higher on a modified ASI measure, (2) they reported being treated for drug abuse within the past month, (3) they reported using drugs intravenously (shooting up),6 or (4) they reported using any of a variety of specific drugs three or more times a week within the past month.7 Clients were classified as having a past year drug use problem if they met these same criteria within the past year (including the past month), and as having a lifetime drug use problem if they met these same criteria in their lifetime or if they reported ever having had three or more drug-related problems (such as blackouts, convulsions, withdrawal symptoms, and/or illegal activities to get money for drugs).

Clients were classified as having a past month mental health problem if any of the following conditions were met: (1) they scored 0.25 or higher on a modified ASI measure, (2) they reported receiving treatment or counseling or being hospitalized for emotional or mental problems within the past month, (3) they reported taking prescribed medications for psychological or emotional problems within the past month, (4) they reported that a mental health condition is the single most important thing keeping them from getting out of homelessness, or (5) they reported receiving treatment or counseling or being hospitalized for emotional or mental problems at some point in their lives and having one or more of the ASI's seven emotional or psychological conditions within the past month.8 Clients were classified as having a past year mental health problem if these same criteria were met within the past year (including the past month), and as having a lifetime mental health problem if these same criteria were met in their lifetime or if they reported ever having stayed in an client group home, crisis residence, or other housing for the mentally ill.

Describing Urban/Rural Location

A number of analyses focus on the geographic location where clients were found, including central cities, suburban and urban fringe areas, and rural areas. Central cities are the main or primary cities of metropolitan statistical areas (MSAs). Suburban and urban fringe areas are defined as what is left of MSAs after taking out the central cities, and may include smaller cities, suburbs, towns, and even open land if it is in the counties making up the MSA. Rural areas are defined as all areas outside of MSAs, and may include small cities (under 50,000 people), towns, villages, and open land.

Statistical Significance of Findings

This report contains many statistics. Some are numbers, such as the number of housing, food, and other programs in the United States. Others are simple percentages, such as the percentage of clients who are male. Still others are comparisons between two groups.

Confidence Intervals

A 90 percent criterion has been used for confidence intervals in this report.

  • For numbers: Ninety percent confidence intervals are given for all estimates of numbers. A 90 percent confidence interval of ±400 means that if the reported number of soup kitchens is 4,000, 4,000 is the estimate of the number of soup kitchens and the probability is 90 percent that the number falls between 3,600 and 4,400.
  • For percentages: Almost all simple percentages reported in the text have a 90 percent confidence interval of no more than ±4 percentage points. A 90 percent confidence interval of ±4 percentage points means that if the reported percent is 60, 60 is the best point estimate and the probability is 90 percent that the true percent falls between 56 and 64 percent. In the few instances when the confidence interval exceeds ±4 percentage points, the actual confidence interval is reported in a footnote with the following notation: 90% C.I. = X percentage points.

Statistical Significance of Comparisons

Comparisons are the other important way that information is presented in this report. When one reports that currently homeless clients include higher proportions of men than do formerly homeless clients, one is making a comparison. A statistical test is used to determine whether the difference between two percentages from different groups is "significant" in the statistical sense. As with confidence intervals, these tests can be calculated for different levels of statistical significance.

A 90 percent criterion has been used for all comparisons in this report. Thus, all comparisons discussed in the text are statistically significant at p = .10 or better, meaning that there is only a 10 percent chance that the difference is not a true difference.

Risk of False Positives

The reader should note that when one conducts a very large number of statistical significance tests, some of them are going to produce false positives, meaning that a difference between two numbers really is not significant, although the test says it is. Thousands of tests for statistical significance were performed on the data contained in this report. The reader is cautioned not to make too much of statistically significant but relatively small differences between populations. Rather, attention is best directed to serious or sizable differences between populations that are most likely to be stable and reliable, and also may have a chance to be important for policy purposes.

Limitations of NSHAPC Findings

There are some important aspects of the NSHAPC study that readers need to know if the study's findings are to be interpreted correctly.

The Study Is Descriptive

This study is intended to provide information describing currently homeless and other clients using homeless assistance programs in the United States. There is no intent to infer causes of homelessness from this descriptive information. Statistics are presented as simply as possible, for ease of understanding. Where information is available, the report compares study findings for homeless clients with statistics describing all American adults, all poor adults, or other relevant national populations. This is intended to help the reader understand similarities and differences between poor people or the population in general and clients experiencing homelessness in the fall of 1996. When a statistic looks simple but actually reflects some hidden third factor, the report tries to point this out. For example, the report shows that veterans comprise a higher proportion of street stayers than they do of shelter stayers. But the report also points out that this is because more street stayers are men and almost all of the veterans in the sample are men, not because veterans have a special propensity for sleeping on the streets.

The People in the Study Come from Homeless Assistance Programs

The people interviewed for NSHAPC are clients of homeless assistance programs. In cities and other communities with many programs, this approach is an efficient and effective way to find and interview a very high proportion of homeless people. However, in communities without many services, this approach will miss many homeless people, and the complete absence of services in a community, and therefore of people interviewed for this study (as happened in two rural sampling areas), cannot be taken to mean that such communities do not have any homeless people.

In addition, there may be some systematic biases in the homeless people who are interviewed and those who are missed when a community does not have a full range of homeless assistance services. If soup kitchens are rare in rural areas, typical soup kitchen users will be less likely to appear in rural homeless samples. If suburbs will accept transitional housing programs for families but not for recovering substance users or people with mental health problems, then a service-based methodology will make suburban homeless populations look as if they have higher proportions of families and lower proportions of clients with mental health or substance use problems.

A service-based approach to data collection is the most reasonable way that a national study of homelessness could be undertaken and still be statistically meaningful. (See the paper by Tourkin and Hubble, appendix A of the Technical Report, for an explanation of why this study used a service-based design.) Local studies can compensate for gaps in a community's service system, but there is no realistic way for a national study to do so. The reader is therefore advised to use caution in interpreting differences in homelessness between communities of different types, as some of the differences will probably reflect service system variations rather than true differences in homeless populations.

NSHAPC Was Designed to Collect Data on Clients Who Use Homeless Assistance Services

Many homeless assistance programs serve clients who are not currently homeless. As a result of the study's random sampling of all program clients, some clients in the NSHAPC sample were not homeless at the time they were interviewed. This is particularly true for programs that are not shelters or transitional housing programs. Information collected during the interview indicated that some have been homeless at least once in their lifetime; this report refers to this group as "formerly homeless" clients. The remaining people, who reported never having been homeless, are referred to as "other service users."

The study designers wanted to know the characteristics of people using the programs, including information about their living situation. The reader should remember that while the study design produces as close to a nationally representative sample of homeless clients as possible, the same is not true for formerly homeless clients and other service users. As unrepresentative of their larger categories as these two subgroups of the sample may be, information about them is important for service providers. These two groups make up almost half of all clients who use homeless assistance programs, so information about their characteristics can be of considerable help to program managers.

All Client Information Comes from the Clients Themselves

The study interviewed clients of homeless assistance programs about their experiences, and recorded their responses. No attempt was made to verify or confirm the accuracy of what clients said about themselves. This is especially important for readers to remember when they review information about the clients' health conditions, use of alcohol and drugs, mental health problems, incarceration, victimization, joblessness, and other possibly sensitive subjects. Clients may not actually know some things, such as medical conditions (e.g., hypertension, anemia), if they do not see doctors regularly. They may have forgotten, or wish to downplay, other things that carry some level of social stigma. Furthermore, many questions were asked and left up to the client to interpret, including such critical issues as whether or not they had ever been homeless (no "official" definition was given or imposed on clients).

What the Study Does Not Do

All studies have limitations, and NSHAPC is no different. This report does not include information on the following issues, because the study was not designed to address them:

  • How many homeless people are there? (Neither the program nor the client component of NSHAPC provides or was intended to provide a count or census of homeless persons in the United States. Such a count would be logistically impossible and prohibitively costly, as the experience of the Street and Shelter Night component of the 1990 Decennial Census clearly showed. Further, NSHAPC misses all homeless people who never contact a homeless assistance program, either out of personal preference or because no programs are available to them. Homeless assistance program estimates of the clients they expect to serve will be inaccurate because they include many clients who are not homeless, as well as an unknowable amount of duplicate counting because clients often use more than one program.)
  • How many homeless people are there in my city/county/state? (The study was not designed to answer this question.)
  • What are the characteristics of homeless people in my city/county/state? (The study can reliably describe homeless people in central cities as a group, suburbs and urban fringe areas as a group, and rural areas as a group. However, it cannot describe population characteristics for smaller geographic areas.)
  • What programs work best? (NSHAPC is not a program evaluation, and does not contain any outcome or impact information.)
  • Are there "enough" services? (This question can only be answered at the local level, using information about the amount of each service that is available and the number of clients who need it.)

It is also important for the reader to remember that this study obtained information about homeless clients and other service users during October-November 1996. As with all information that focuses on homeless people at a single point in time, it will overemphasize people with long episodes of homelessness and underemphasize people with short periods of homelessness and also people who are homeless for the first time. Any characteristics associated with length of a homeless episode will likewise be skewed toward the characteristics of people with longer spells of homelessness.

The Structure of This Report

The remainder of this report presents information about people who use homeless assistance programs included in NSHAPC, referred to throughout as clients, and programs and service locations. Chapter 2 presents an overview of homeless clients for the most general findings within each of the study's topic areas. Chapter 3 looks at the same findings, asking whether currently homeless clients differ in important ways from those who were once but are not now homeless, and other users of homeless assistance programs who do not report any episode of homelessness. Chapter 4 describes homeless assistance programs, including program type, size, auspices (nonprofit, government, private), funding, population groups for which the programs have a special focus, and services offered. It also examines the availability of shelter/housing services and soup kitchen meals in relation to the total population and population in poverty in 1990 of each of the study's 76 primary sampling areas. A brief conclusion is provided in the Postscript. Appendix A provides a list of the 76 sampling areas used in the study. Appendix B provides the NSHAPC definition of a "homeless assistance program" and full descriptions of the 16 types of homeless assistance programs included in the study.

Additional Information May Be Found in the Technical Report

Readers who would like to examine more detailed information about the topics summarized in this report or who would like to review study methods, survey instruments, and other technical details should review the companion technical volume to this report, Homelessness: Programs and the People They Serve—Technical Report. After an introductory chapter and a chapter summarizing methods, chapters 3 through 13 present information about clients and chapters 14 through 17 cover topics related to homeless assistance programs. Chapter topics are

  • Chapter 3: demographic characteristics.
  • Chapter 4: history of homelessness among currently and formerly homeless clients.
  • Chapter 5: income, income sources, employment and unemployment, and participation in government programs.
  • Chapter 6: physical health conditions and access to medical and dental treatment.
  • Chapter 7: food situation of clients, including food problems and food access.
  • Chapter 8: special needs, including past month, past year, and lifetime alcohol, drug, and mental health problems; treatment experiences related to these problems; incarceration history; and victimization while homeless.
  • Chapter 9: service needs from the client's perspective.
  • Chapter 10: adverse childhood experiences, including out-of-home placement, victimization, runaway and homeless experiences, and early involvement with drugs and alcohol.
  • Chapter 11: veterans.
  • Chapter 12: children in homeless families.
  • Chapter 13: characteristics of homeless clients in central city, suburban, and rural locations.
  • Chapter 14: basic characteristics of homeless assistance programs.
  • Chapter 15: population focuses of homeless assistance programs.
  • Chapter 16: service offerings of homeless assistance programs.
  • Chapter 17: variations in service availability among NSHAPC's 76 sampling areas.

Five appendices are attached to the Technical Report: Appendix A: NSHAPC's 76 sampling areas.
Appendix B: NSHAPC program definitions.
Appendix C: explanation of the NSHAPC study and sampling design.
Appendix D: explanation of weighting.
Appendix E: NSHAPC data collection instruments.


2 An Overview of Homeless Clients


HIGHLIGHTS

Homeless Clients1
  • Among homeless households (that is, the one or more people represented by each NSHAPC client), 15 percent are family households (that is, they include the client and one or more of the client's minor children). If one includes all minor children living with homeless clients, then 34 percent of homeless people found at homeless assistance programs are members of homeless families and 66 percent are not.
  • Homeless clients are predominantly male (68 percent) and nonwhite (53 percent). Large proportions are also never married (48 percent) and poorly educated (38 percent have less than a high school diploma). These characteristics contrast sharply with those of the U.S. population as a whole (48 percent male, 14 percent nonwhite, 23 percent never married, and 18 percent with less than a high school education).
  • Sixty percent of homeless women have minor children, as do 41 percent of homeless men. Among these minor children, only 28 percent live with their homeless parent and 72 percent do not. Twenty percent of the children living with a homeless parent are infants and toddlers (ages 0 to 2), 22 percent are preschoolers (ages 3 to 5), another 33 percent are of elementary school age (6 to 11), and 20 percent are adolescents (ages 12 to 17). Age was not given for 5 percent.
  • Finding a job is the top need reported by homeless clients (42 percent).
  • Thirty percent of homeless clients cited insufficient income and another 24 percent cited lack of employment as the single most important thing preventing them from leaving homelessness.
  • Homeless clients often have a hard time getting enough food. Fifty-eight percent report at least one problem with getting enough food to eat during the 30 days before being interviewed.
  • Fifty-five percent of homeless clients have no health insurance, and 24 percent say they needed medical attention in the past year but were not able to get it.
  • Alcohol problems during the past month are reported by 38 percent of homeless clients, drug problems by 26 percent, and mental health problems by 39 percent. Sixty-six percent reported problems with one or more of these issues during the month before they were interviewed.
  • Being homeless leaves one's person and possessions vulnerable to attack. Thirty-eight percent of homeless clients report having money or things taken directly from them while homeless, and 41 percent report thefts of their possessions while they were not present. In addition, 22 percent have been physically assaulted and 7 percent sexually assaulted while homeless.
  • Over one-quarter (27 percent) of homeless clients lived in foster care, a group home, or other institutional settings for part of their childhood. Twenty-five percent report childhood physical or sexual abuse. In addition, many had childhood experiences of homelessness (21 percent), running away from home (33 percent), or being forced to leave home (22 percent).
  • The incomes of homeless clients are extremely low. Mean income during the 30 days before being interviewed was $367. Mean income for clients living with their children was higher ($475), but was still only 46 percent of the 1996 federal poverty level of $1,023/month for a family of three. Single homeless clients report less income, averaging $348 during the past month, or just 51 percent of the 1996 federal poverty level of $680/month for one person. By comparison, the median monthly income for all American households was $2,840 in 1995, indicating the extreme poverty of homeless clients whether they be families or singles.
  • Forty-four percent of homeless clients worked for pay during the last 30 days, but less than half of these workers had a regular job (one lasting or expected to last three months or more).
  • The means-tested government benefits with the highest rates of participation among homeless clients were food stamps (37 percent) and Medicaid (30 percent). Participation in cash assistance included Aid to Families with Dependent Children (AFDC) (52 percent among homeless families), General Assistance (GA) (9 percent), and Supplemental Security Income (SSI) (11 percent). Household status did not affect receipt of the latter two benefits, but homeless families were much more likely than other homeless clients to receive food stamps and Medicaid. All 1996 rates of participation in government benefit programs are significant improvements over participation rates for homeless clients in 1987.
  • Almost half (49 percent) of homeless clients have been homeless only once, but 22 percent have been homeless four or more times. Current spells of homelessness in this point-in-time study are about equally likely to be short (28 percent were three months or less) and long (30 percent were two years or more). Homeless families are more likely than single homeless clients to be in a first episode that has lasted less than six months (34 versus 15 percent).
  • About one-third (32 percent) of homeless clients spent time as "street homeless" during the week before being interviewed.
  • Homeless clients changed their location frequently in the week before being interviewed, revealing a great deal of overlap among clients sleeping in places not meant for habitation, shelters, and temporary accommodations. Seventy-three percent used shelters, of whom slightly more than half also had slept in other arrangements and/or on the streets. Thirty-two percent slept on the streets, of whom 4 out of 5 also slept in shelters and/or other arrangements. Fifty-five percent had slept in other arrangements, of whom 9 out of 10 had also slept in shelters and/or on the streets.
  • The majority of homeless clients (71 percent) are in central cities, 21 percent in the suburbs and urban fringe areas, and 9 percent in rural areas. This contrasts with the distribution of the U.S. population in poverty of 43, 34, and 23 percent, respectively.
  • Comparing findings from the Urban Institute's 1987 study of central city homeless shelter and soup kitchen users with equivalent 1996 NSHAPC clients reveals both continuity and change during this nine-year period. There is no change in the proportion of homeless clients in the two time periods who are male, Hispanic, in families, or homeless for two years or more, or who have experienced inpatient treatment for alcohol and/or drug and mental health problems. The biggest changes are evident in increases from 1987 to 1996 in the proportion of clients whose current homelessness has lasted three months or less, who receive AFDC2 (family households only), SSI, and food stamps; an increase in mean monthly income per person after adjusting for inflation; and decreases in the proportion with less than a high school education, who have never married, and who have problems getting enough to eat.


Introduction

Homelessness has been recognized as a significant social problem in the United States for many years. In the early 1980s, when homelessness gained prominence as a social phenomenon, views of the issues it posed were relatively simple. Some observers felt that the problem was a temporary consequence of the recession of 1981-1982, and would go away when the economy recovered, while others argued that the problem stemmed from a lack of affordable housing and that homeless clients were simply a cross section of poor Americans.

Knowledge gained about homelessness and homeless people since the early 1980s provides a more complicated picture. Studies leave no question that extreme poverty is the virtually universal condition of clients who are homeless, and that this poverty is one reason they cannot maintain themselves in housing. However, many people who are very poor never become homeless. Other vulnerabilities characterize many homeless people, such as low levels of educational achievement, few job skills, exhaustion of social supports or complete lack of family, problems with alcohol or drug use, severe mental illness, childhood and client experiences of violence and victimization, and incarceration as a child or client. Together with extreme poverty, these vulnerabilities increase a person's risk of becoming homeless when faced with a financial or personal crisis.3 In addition, decreases in the availability of housing at prices affordable to clients in low-wage employment and increases in the skill levels needed to obtain employment beyond the low-wage level have changed many local environments into ones that make it more difficult for very poor clients to make ends meet even if they have no other vulnerabilities.

This chapter includes information about many issues that may increase a person's vulnerability to homelessness. It describes homeless service users in very basic ways, such as their sex, age, race, and marital status. Other pieces of the picture of homelessness are then explored, including client reports of service needs, hunger, physical health conditions, mental health problems, problems with alcohol and other drugs, and history of incarceration, victimization, and childhood experiences of out-of-home placement.

Thereafter, the chapter describes clients' use of various homeless assistance programs and examines similarities and differences in the characteristics of clients who use different types of programs, and those who sleep on the streets.

It shows clients' geographical location, household status, history of homelessness, and length of current homeless spell to describe variations in the conditions of their homelessness. It then turns to one of the underlying realities of virtually all homelessness, namely, income levels, income sources, and low levels of significant labor force participation.

The chapter ends with two important comparisons. The first is an examination of similarities and differences among homeless clients in central cities, suburban and urban fringe areas, and rural areas. The second is a comparison of 1987 Urban Institute and 1996 NSHAPC findings, examining ways in which homeless populations have changed or remained the same.

Demographic Characteristics of Homeless Clients4

On most basic demographic characteristics, homeless clients differ considerably from the population of the United States. In addition, the parents in homeless families using services, who comprise 15 percent of the homeless clients to NSHAPC survey, also differ from single homeless clients on many of these same factors. Table 2.1 presents the relevant information. The Ns shown at the top of this and all other tables are unweighted. Percentages are based on weighted data.


Table 2.1
Demographic Characteristics of Homeless Clients by Family Status
  U.S. Adult Population (1996) All Homeless Clients Clients in Homeless Families Single Homeless Clients
    (N=2938) (N=465) (N=2473)
Sexa
Male 48(%) 68(%) 16(%) 77(%)
Female 52 32 84 23
Race/Ethnicityb
White non-Hispanic 75 41 38 41
Black non-Hispanic 11 40 43 40
Hispanic 10 11 15 10
Native American 1 8 3 8
Other 3 1 1 1
Agea
Under 25 13 12 26 10
25 to 54 yrs. 59 80 75 81
55 or more yrs. 28 8 * 9
Marital Statusc
Never Married 23 48 41 50
Married 60 9 23 7
Separated f 15 23 14
Divorced 10 24 13 26
Widowed 7 3 0 4
Educational Attainmentd
Less than High School 25 38 53 37
High School Graduate/G.E.D. 30 34 21 36
More than High School 45 28 27 28
Veterane 13 23 5 26

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100% due to rounding.
* Denotes percentage less than 0.5 percent but greater than 0.
Sources for U.S. adult population data:
a Bureau of the Census (1997a), data for 1996; table 14, N = 200 million. Age range is 18 to 64.
b Ibid., table 23, N = 196.2 million.
c Ibid., table 58, N = 193.2 million.
d Ibid., table 245, N = 168.3 million persons 25 and older.
eDepartment of Veterans Affairs, data for 1995.
f Included in "married."

Demographic characteristics of all U.S. adults appear in the first column of table 2.1 as a point of comparison to the homeless clients who participated in the NSHAPC survey. The second column describes these homeless clients. The third and fourth columns break out NSHAPC homeless clients into those who are with their own children (homeless families), and those who are not (single homeless clients).

Figure 2.21

Sex

As in other studies, men dominate among homeless clients, comprising 68 percent of this group compared to 48 percent of all U.S. clients in 1996 (figure 2.1).5 However, these statistics mask considerable differences in the sex of homeless clients in homeless families and single homeless clients. Among homeless clients in families, 84 percent are women and 16 percent are men (figure 2.2). Among single homeless clients, the sex ratio is reversed; only 23 percent are women and 77 percent are men (table 2.1).

Figure 2.2

Race/Ethnicity

Homeless clients are about equally divided between non-Hispanic whites and blacks (41 and 40 percent, respectively), with 11 percent Hispanics, 8 percent Native Americans, and 1 percent "other" (figure 2.3). Compared with all U.S. adults in 1996, homeless clients are disproportionately black non-Hispanics (11 versus 40 percent) and Native American (1 versus 8 percent).6 The racial/ ethnic makeup of homeless clients does not differ by family status.

Figure 2.3

Age

The overall statistics on the ages of homeless clients mask very great differences between homeless clients in families and single homeless clients. Clients in families are much younger, as shown in their higher probability of being ages 24 and younger (26 versus 10 percent) and lower probability of being ages 55 and older (less than 0.5 percent versus 9 percent) (figure 2.4). This age distribution is quite different from that of all U.S. adults, in which only 14 percent are under 25 years of age and 28 percent are ages 55 and older.7



Figure 2.4


Marital Status

Forty-eight percent of homeless clients have never married. Among the 52 percent who have been married at one time or another, most have seen those marriages dissolve through divorce (24 percent) or separation (15 percent) without subsequently entering into another marriage. These patterns are repeated among single homeless clients, and modified somewhat among homeless clients in families (figure 2.5). The latter group is more likely to report being married (23 versus 7 percent) and less likely to report being divorced (13 versus 26 percent). In addition, they are less likely never to have married (41 versus 50 percent), but the proportion who have never married is still high compared to all U.S. adults at 23 percent.8

Figure 2.5

Education

Thirty-eight percent of homeless clients have dropped out of high school, while for 34 percent, a high school diploma is their highest level of completed education. Fewer, but still more than one-quarter, have some education beyond high school. These figures differ considerably between clients in families and single homeless clients (figure 2.6). Clients in families are more likely to have ended their education before completing high school (53 versus 37 percent), and less likely to have exactly a high school diploma or G.E.D. (21 versus 36 percent). However, the two groups are equally likely to have received some education beyond high school. Homeless clients are less educated than the adult U.S. population: only 25 percent of American adults (those ages 25 and older) have less than a high school education, 34 percent have a high school diploma, and 45 percent have some education beyond high school.9

Figure 2.6

Veteran Status

Twenty-three percent of homeless clients are veterans. Examined separately by sex, 1 percent of homeless women are veterans compared to 33 percent of homeless men. For men, this proportion is not different from the 31 percent of the general client male population whom the Department of Veterans Affairs estimates were veterans in 1996, but somewhat lower than the 40 percent of veterans among homeless men found in a systematic synthesis of data from other studies of homeless populations (Rosenheck et al. 1996).


The Children of Homeless Clients

Many more homeless clients are parents than is indicated by the proportion who have at least one of their children with them. Among homeless women, 60 percent have children under age 18, but only 65 percent of them live with at least one of these children. Among homeless men, 41 percent have children under age 18, but only 7 percent of these fathers live with at least one of their own children.10 Looked at from the children's perspective, 28 percent of minor children of homeless parents live with that parent, while 72 percent do not.

Homeless families have, on average, two children. Members of these families comprise 34 percent of all homeless people using services. As this figure (34 percent) is quite different from the figure noted earlier—15 percent of homeless clients are heads of homeless families—some clarification is in order. The two figures illuminate a common confusion about the term "homeless family." Only 15 percent of homeless households contain an client and at least one minor child, which is a common definition of "family" used in the context of homelessness research. However, when one counts clients and children together, 34 percent are in families. Two-thirds of these are children.

Children in homeless families using services are fairly evenly divided between males (53 percent) and females (47 percent), which does not differ from American children generally (table 2.2). They are disproportionately younger than school age (ages 0 to 5) compared to all U.S. children (42 versus 34 percent).11 Parents report that almost half (45 percent) of these children ages 3 to 5 attend preschool. In addition, almost all (93 per- cent) of school-age children (ages 6 to 17) are reported to attend school regularly.12

Homeless clients in families (table 2.1) and the children themselves (table 2.2) are similarly distributed among racial/ethnic groups. These similarities are due in large part to the fact that children's race/ethnicity was attributed from that of their parents, but also implies that the number of children homeless with their parent(s) does not differ systematically in relation to the parent's race or ethnicity.

NSHAPC parents' reports of their children's school attendance can be compared with data about school enrollment of U.S. children (table 2.2). Forty-five percent of the 3- to 5-year-old children accompanying homeless NSHAPC clients are reported to be attending preschool. Parents also say that 93 percent of their children ages 6 to 17 attend school regularly. The closest comparable figures for all U.S. children are for enrollment rather than for attendance. They indicate that 49 percent of 3- to 4-year-olds and 98 percent of 5- to 17-year-olds are enrolled in school.13 These figures are comparable to NSHAPC information about homeless children.


Table 2.2
Characteristics of Children under 18 Living with Homeless Parent and the U.S. Population of Children
  Children Under 18 (N=1007) U.S. Population, 1996: Children
Child's Sexa    
Male 53(%) 51(%)
Female 47 49
 
Child's Ageb    
0 to 2 20 17
3 to 5 22 17
6 to 8 20 17
9 to 11 13 17
12 to 14 11 16
15 to 17 9 16
Not answered 5 -
 
Child's School Attendance/Enrollment Attendance Enrollmentc
Age 3-5, % attending preschool 45 49
Age 6-17, % attending school regularly 93 98
 
Parent's Race/Ethnicityb
White non-Hispanic 38 66
Black non-Hispanic 47 15
Hispanic 13 14
Native American 2 1
Other 1 4
 
In Household Receiving Government Benefits   Children in Poor Householdsd
Food Stamps 70 66
AFDC 51 55f
SSI 12 f
Medicaid 73 69

Source: Urban Institute analysis of weighted 1996 NSHAPC client data. Information was collected on each child's sex, age, school attendance, and enrollment in Medicaid. Other information is assigned to each child based on the client-parent's characteristics.
Sources for U.S. child population data: aBureau of the Census (1997a),data for 1996, 16, N=69.5 million.
bIbid., table 22.
cBureau of the Census (1997b), data for 1995, table 1, N=59.0 million 3-to 17-year-olds, data reflect enrollment, not attendance, the 49 percent pertains to 3- to 4-year olds and the 98 percent pertains to 6- to 17-year-olds.
dBureau of the Census (1992); P60-181, data for 1991, table E, N=13.7 million children ages 0 to 17.
eThis 55 percent is for children in households receiving any cash assistance, which could include AFDC, SSI General Assistance, or other means-tested cash benefits.


Homeless children live in households whose receipt of government benefits is quite similar to that of nonhomeless children in poor U.S. households. Seventy percent of children in homeless families receive food stamps, which does not differ from the 66 percent of poor U.S. children who do so. Nor does the proportion of both groups covered by Medicaid differ (73 percent of homeless and 69 percent of poor U.S. children). It is harder to tell whether differences exist between homeless and nonhomeless poor children in their family's receipt of cash assistance because the data are not reported in the same categories. Fifty-one percent of homeless children live in families receiving AFDC, and 12 percent live in families receiving SSI. The Bureau of the Census (1992, table E) reports that 55 percent of nonhomeless poor children live in households receiving cash assistance, which could be AFDC, SSI, General Assistance, or other means-tested cash benefits.

Combining homeless children with their homeless parent and with single homeless clients, table 2.3 shows how all homeless service users compare to the U.S. population in poverty on some basic demographic characteristics.14 All homeless service users include considerably more males than the overall American poverty population (65 versus 43 percent). They are less likely to be white (47 versus 67 percent) or Hispanic (11 versus 24 percent), and more likely to be black (42 versus 27 percent). They are also less likely to be children (24 versus 40 percent), less likely to be ages 55 and older (7 versus 15 percent), and more likely to be in their middle years (42 versus 19 percent are between the ages of 35 and 54).


Table 2.3
Demographic Characteristics of Homeless Adults Plus Their Children Living with Them, Compared with the U.S. Population in Poverty and the General U.S. Population
  Homeless Persons (Adults Plus Children)a (N=3945) Poor Persons, 1996b (All ages) (N=36.5 million) U.S. Population, 1996c (N=266.2 million)  
Sex        
Male 65(%) 41(%) 49(%)  
Female 35 59 51  
   
Race        
White 47 67 83  
Black 42 27 13  
Other 11 6 5  
   
Hispanic Origin 11 24 11  
   
Age        
Under 18 24 40 26  
18 to 24 yrs. 4 12 14  
25 to 34 yrs. 19 14 15  
35 to 44 yrs. 29 12 16  
45 to 54 yrs. 13 7 12  
55 to 64 yrs. 5 6 8  
65 or more yrs. 2 9 13  

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100% due to rounding.
aClients plus any of their own children ages 0 to 17 who live with them. Children's race/ethnicity is assigned based on parent's.
bSources for poverty population data: Lamison-White (1997), P60-198; sex, table 2; race, Hispanic origin, and age, table A.
cSources for U.S. population data: Bureau of the Census (1997a), sex and race, table 21, Hispanic origin, table 23, age, table 16.


The last issue of importance with respect to children of homeless clients is the question of where children are when they are not with their homeless parent. The answer is heavily dependent on the homeless clients' sex (figure 2.7). When the homeless client is male, his children who do not live with him are most likely to be with their (nonhomeless) mother (81 percent of male homeless clients' minor children). But only 23 percent of female homeless clients' minor children who do not live with their mother live with their father. The woman's own parents or other relatives are most likely to be caring for her children if they are not with her (46 percent of children of female homeless parents), and about one-fifth (19 percent of homeless women's minor children) are in foster care or group homes.

Service Needs, Stresses, and Vulnerabilities

Service Needs as Seen by Clients

Clients were asked to name the three things they needed most "right now," and also to identify the single most important thing keeping them in a homeless condition. Help finding a job was the most frequently cited need (42 percent), followed by help finding affordable housing (38 percent), and assistance with paying rent, mortgage, or utilities in relation to securing permanent housing (30 percent). Other needs cited by more than 10 percent of clients were assistance with transportation (19 percent), clothing (18 percent), food (17 percent), job training and medical care (13 percent each), and a GED and dental care (11 percent each).

Figure 2.7

Insufficient income was cited most frequently as "the single most important thing" keeping the client homeless, at 30 percent of all homeless clients (figure 2.8). An additional 24 percent cited lack of a job or employment. Lack of suitable housing was mentioned by 11 percent of homeless clients, and addiction to alcohol and/or drugs by 9 percent. No other categories except "other" (14 percent) were reported by many clients.

Figure 2.8

Food Consumption and Hunger

NSHAPC clients were asked a basic question about the sufficiency of the food they eat. Twenty-eight percent of homeless clients report that they sometimes or often do not get enough to eat. Only 39 percent get enough of the kinds of food they want to eat. This contrasts with 60 percent of poor U.S. households and 80 percent of all U.S. households who say they get enough of what they want to eat.15 Other food problems experienced by homeless clients include usually eating one meal a day or less (20 percent); being hungry in the past 30 days but not eating because one could not afford enough food (39 percent); and going a whole day without eating anything at all in the last 30 days (40 percent) (figure 2.9).

Data for some of these problems from poor U.S. households indicate that homeless clients have much higher levels of food problems than poor people generally. Thirty-nine percent of homeless clients versus 5 percent of poor households reported that in the last 30 days they were hungry but didn't eat because they couldn't afford to buy food, and 40 versus 3 percent said they didn't eat for one whole day or more because they couldn't afford to buy food.

Figure 2.9

An index of food problems based on clients' reported hunger and difficulties obtaining adequate food was also calculated. This five-level index reports the percentage of homeless clients reporting none, one, two, three, or four food problems. On this index, 42 percent of homeless clients report no food problems. By contrast, 37 percent have two or more food problems.

Victimization while Homeless

In addition to the stresses of finding enough food to eat, being homeless removes the safety of a permanent residence and leaves one's person and possessions vulnerable to attack. Robbery and theft are common threats experienced by two in five homeless clients (figure 2.10). Thirty-eight percent of homeless clients report having money or things stolen directly from them while they were present (robbery), and a similar proportion (41 percent) report having money or things stolen from their bags, locker, or other location while they were gone (theft). In addition, 22 percent report being physically assaulted or beaten up at least once while homeless, and 7 percent report being sexually assaulted or raped.

Figure 2.10

Physical Health Status and Insurance

Survey clients were given a list of 17 medical conditions and asked if they had any of them. These include conditions classified as

  • acute infectious conditions (chest infection/cold/ cough/bronchitis, pneumonia, tuberculosis, STDs other than AIDS);
  • acute noninfectious conditions (skin diseases, lice/ scabies); or
  • chronic health conditions (diabetes, anemia, high blood pressure, heart disease/stroke, liver problems, arthritis/rheumatism, cancer, problems walking/lost limb/other handicap, HIV/AIDS), as well as "other" conditions.

Reported rates of these conditions may be underestimates because they rely on client self-reports. These self-reports may be low due to lack of knowledge or diagnosis of medical conditions, or reluctance to admit to having some of them. It is also possible that if the interview had inquired about other conditions, reported rates would be higher. Twenty-six percent of clients report one or more acute infectious conditions, 8 percent report one or more acute noninfectious conditions, and 45 percent report one or more chronic health conditions. Three of the four most commonly reported medical conditions are chronic health conditions: arthritis, rheumatism, or joint problems (24 percent); high blood pressure (15 percent); and problems walking, a lost limb, or other handicap (14 percent). Chest infection, cold, cough, or bronchitis (acute infectious conditions) are also among the most highly reported, at 22 percent.

Twenty-four percent of homeless clients report that they needed medical attention in the past year but were not able to get it. Forty-six percent could not get access to a dentist when one was needed. This lack of access may be due in part to their general lack of insurance coverage. Fifty-five percent report that they have no medical insurance of any kind; the comparable figure for all American adults is 16 percent. By contrast, 30 percent say they are covered by Medicaid, 7 percent by medical care through the Department of Veterans Affairs, 4 percent by private insurance, and 10 percent by insurance of other types. A few clients mentioned more than one type of insurance.

Among homeless clients in family households, 10 percent report that their children needed to see a doctor or nurse in the past year but were not able to do so. Homeless children are much less likely than homeless clients to be without insurance coverage. Only 20 percent of homeless family households have no insurance for their children. Seventy-three percent16 report Medicaid coverage for their children, while 6 percent have private insurance coverage and 6 percent have some other type of medical insurance coverage for their children (some clients in family households mentioned more than one type of insurance).


Table 2.4
Alcohol, Drug, and Mental Health (ADM) Problems among Homeless Clients
ADM Combinations Past Month Past Year Lifetime
Any ADM Problema 66(%)b 74(%) 86(%)
 
Alcohol Problem 38 46 62
Drug Problem 26 38 58
Mental Health Problem 39 45 57
 
Specific Combinations:
Alcohol problem only 13 12 9
Drug problem only 7 7 6
Mental health problem only 17 15 10
Alcohol and drug problems 7 10 15
Alcohol and mental health problems 10 10 9
Drug and mental health problems 5 7 8
Alcohol, drug, and mental health problems 8 14 30
No ADM problems 34 26 14

Source: Urban Institute analysis of weighted 1996 NSHAPC Client data.
Note: Percentages do not sum to 100% due to rounding. * Denotes values that are less than .5 percent but greater than 0.
aThese ADM measures include a small number of cases (21 for the past month, 3 for the past year, and 5 for lifetime) who answered questions suggesting they had a substance use problem (questions 2.11a(13b), 3.15a(13b), and 14c(5)) but did not satisfy any other specific criteria for alcohol or drug problems. Because the precise nature of the problem cannot be determined from these measures, they are not included in the problem-specific measures.
bThis is the measure used throughout this report as the ADM standard break.


Alcohol, Drug, and Mental Health Problems

Clients were asked about experiences considered to be indicators of alcohol, drug, and mental health (ADM) problems, and about treatment experiences related to these problems. Responses to questions were combined to categorize clients as having or not having particular problems during the past month, past year, and/or their lifetime (see chapter 1 for details on how alcohol, drug, and mental health problems were defined). When looking at the results, it is important to remember that NSHAPC information is not based on clinical diagnoses.

Past Month. Homeless clients report a variety of problems with mental or emotional conditions, alcohol use, or use of illegal drugs within the past 30 days (table 2.4). During this period 38 percent report problems with alcohol use; 26 percent report problems with drug use, and 39 percent report mental health problems.

Sixty-six percent of homeless clients report one or more of these problems during the past month (figure 2.11). Thirteen percent report only alcohol problems, 7 percent report only drug problems, 17 percent report only mental health problems, 22 percent report combinations of two problems, and 8 percent report all three problems during the past month.

Past Year. The longer time period of the past year (including the past month) captures a larger proportion of homeless clients who report one or more problems with mental or emotional conditions, alcohol use, or use of illegal drugs. During this period, 46 percent report problems with alcohol use; 38 percent report problems with drug use, and 45 percent report mental health problems. Seventy-four percent of homeless clients report one or more of these problems during the past year (figure 2.11). Twelve percent report only alcohol problems, 7 percent report only drug problems, 15 percent report only mental health problems, 27 percent report combinations of two problems, and 14 percent report all three problems during the past year.

Lifetime. As the longest time period being considered, it is not surprising that lifetime histories reveal the highest level of problems. During their lifetime, 62 percent of homeless clients report problems with alcohol use; 58 percent report problems with drug use, and 57 percent report mental health problems. Eighty-six percent of homeless clients report one or more of these problems during their lifetime (figure 2.11). Nine percent report only alcohol problems, 6 percent report only drug problems, 10 percent report only mental health problems, 32 percent report combinations of two problems, and 30 percent report all three problems during their lifetime.

Overall Patterns. Looking over the three time periods examined, it is clear that as the time period lengthens more clients report problems in each area. Second, as the time period lengthens the proportion of clients who report a single problem decreases and the proportion who report combinations of two or three problems increases. Third, in each succeeding time period the difference decreases in the proportion reporting problems with alcohol compared to the proportion reporting drug problems, until for lifetime problems the difference is no longer statistically significant. Fourth, the proportion reporting combinations involving mental health problems plus alcohol and/or drug problems increases from 23 percent during the past month to 31 percent during the past year up to 47 percent over clients' lifetimes,17 with the most dramatic increase occurring in the proportion reporting all three.

Figure 2.11

History of Incarceration

About half (49 percent) of homeless clients have spent five or more days in a city or county jail in their lifetime. Some of these jail experiences may have been a direct result of their homelessness (i.e., the charges might be for behaviors that are difficult to avoid if one is homeless, such as loitering). Eighteen percent of clients have been in a state or federal prison, and 16 percent were held in juvenile detention at least once before reaching their 18th birthday. Altogether, 54 percent have some experience of incarceration.

Adverse Childhood Experiences

Ever since a Minneapolis study (Piliavin, Sosin, and Westerfelt 1993) identified childhood out-of-home placement in foster care as a common experience of homeless people, interest has been focused on these early separations from family and the ways that lack of family support after age 18 (when one has to leave foster care) might increase a young person's risk of homelessness. Homeless clients in the present study reveal that 27 percent were placed in foster care, a group home, or other institutional setting before their 18th birthday (figure 2.12). Many experienced multiple placements, as 12 percent were in foster care, 10 percent had been in a group home, and 16 percent had been in residential institutions.

Twenty-nine percent of homeless clients also report abuse or neglect in childhood from someone in their household (12 percent neglect, 22 percent physical abuse, and 13 percent sexual abuse). Thirty-three percent ran away from home and 22 percent were forced to leave home for at least 24 hours before they reached age 18. In addition, 21 percent report that their first period of homelessness predated their 18th birthday (this homelessness might have been with their family or on their own).

Figure 2.12
Where Homeless Clients Were Living

Even within the week documented by this study, homeless clients did not stay in one place. On the day of their interview and the seven days preceding it, many clients slept or rested in a number of different places. These could include places not meant for human habitation; emergency or transitional shelters; or temporary arrangements such as a house, apartment, or room in which someone is allowed to stay on a temporary basis.

Thirty-two percent of homeless clients slept or rested in places not meant for human habitation (designated "streets" in figure 2.13), including transportation depots, commercial spaces, cars or other vehicles, abandoned buildings, outdoor locations, and other venues of similar type. Thus just under one-third of homeless clients would have been found during a typical week's time using such places for sleep.

Homeless shelters are the most common type of location where homeless clients may be found. More than twice as many homeless clients (73 percent) slept in one or more of a variety of shelters during the eight-day period being examined as slept in places not meant for human habitation during the same period. Some, of course, slept in both types of venue. Shelters take many forms, including emergency shelters, transitional housing programs, and vouchers for emergency housing (designated "shelters" in figure 2.13).



Figure 2.13

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
*Client used option at least once during the eight days including the day of the interview and the previous seven days, including being sampled at the site.
"Shelters"=emergency and transitional shelters and voucher programs; "Streets" =any place not meant for habitation; "Temporary Housing"= own or other person's house, apartment, or room, including hotel/motel room that client paid for, but without the possibility of sleeping there for the next month without being asked to leave.


In addition, figure 2.13 shows that 54 percent of homeless clients slept or rested in one or more temporary accommodations,18 including a friend's or relative's place, their own place, a hotel or motel room they paid for themselves, or a permanent housing program for formerly homeless people (designated "temporary accommodations" in figure 2.13).

To understand how extremely transient homeless clients are, it is important to examine the overlap in these categories. Six percent of homeless clients had slept or rested in all three venues during the eight-day period. At the other extreme, 7 percent had stayed only on the streets, 34 percent had stayed only in shelters, 6 percent had stayed only in temporary housing. The overlap is greatest for shelters and temporary accommodations, with 34 percent of homeless clients using both during the eight-day period. By contrast, the overlap between streets and shelters is quite low, with only 11 percent of homeless clients staying in both.

Characteristics of Clients Using Different Housing and Other Services

People staying in the different venues displayed in figure 2.13 are quite different from each other on a number of dimensions of importance to planners, service providers, and others offering assistance to homeless clients. To understand these differences, table 2.5 presents some basic descriptive information for clients who slept on the streets on the day of the interview and/or the previous seven days, and clients who during the same time period stayed in a shelter, used a soup kitchen, or used other types of homeless assistance programs. These groups are not mutually exclusive; many clients fall into more than one of them, and some clients could be included in all four.

Men are a similar proportion of clients who slept in the streets and those who used a soup kitchen during the last eight days (86 and 85 percent, respectively) and are more likely to be found in those venues than in shelters or other programs (where they comprise 65 and 67 percent of users). Few significant racial/ethnic differences exist between the four venues. Shelter stayers are more likely to be in a first homeless episode lasting six months or less (22 percent) than is true for any other group.

Table 2.5 also reports the prevalence of several subgroups within the four service use patterns. Relatively few survey clients in any venue are youth ages 24 and younger. Clients in homeless families are a larger proportion of shelter users (16 percent) and users of other programs (14 percent) than they are of street stayers (3 percent) or users of soup kitchens (6 percent). Persons reporting HIV/AIDS are a very small proportion (2 to 5 percent) in every venue.

More than half of clients in each venue have not done any work for pay in the last 30 days. Street stayers and users of other programs are less likely than shelter stayers to have done any paid work, and users of other programs are also less likely than soup kitchen users to have worked for pay during the past month.

The presence of any alcohol, drug, and/or mental health problems is highest among street stayers and those who used other programs (75 and 74 percent, respectively). Rates are lower but still considerable among homeless clients using shelters and soup kitchens (63 and 66 percent, respectively). Problems with drug use are lowest among shelter stayers (23 percent), and do not differ among clients using the other venues (31 to 35 percent). Both street stayers (45 percent) and other program users (43 percent) are more likely to report alcohol use problems than are shelter stayers (35 percent). The only significant difference by venue for mental health problems is that a higher proportion of users of other programs (46 percent) report such problems compared to those who stayed in a shelter (38 percent) or those who used a soup kitchen (37 percent).

These findings with respect to shelter and other program venues probably reflect the differing influences of program goals and rules. Many transitional housing programs are designed explicitly for clients with these problems, but many emergency shelters have rules that explicitly or effectively exclude clients with these problems, leaving the streets as their only alternative. Users of both types of programs are combined in the shelter user category. Further, some "other programs," especially outreach programs, drop-in centers, and permanent housing programs are explicitly designed to reach and serve clients with alcohol, drug, and/or mental health problems.19


Table 2.5
Demographic and Other Characteristics of Homeless Clients, by Street Location and Program Use in Past Week
  Program Use
  All Homeless Clients Slept on Streets Stayed in a Shelter Used a Soup Kitchen Used Other Program
  (N=2938) (N=768) (N=2352) (N=1727) (N=909)
Sex          
Male 68(%) 86(%) 65(%) 85(%) 67(%)
Female 32 14 35 15 33
Race/Ethnicity
White non-Hispanic 41 40 41 38 35
Black non-Hispanic 40 38 39 39 45
Hispanic 11 13 11 13 11
Native American 8 7 8 10 8
Pattern of Homelessness
First time homeless          
6 months or less 18 10 22 14 11
more than 6 months 31 35 30 31 38
Not first time homeless          
current spell 6 months or less 21 23 21 25 18
current spell more than 6 months 30 32 28 31 33
Other Characteristics          
Youth (17-24) 12 9 13 8 11
Living with own child < 18 15 3 16 6 14
No paid work last 30 days 56 61 53 56 65
Any ADM problem, past 30 days 66 75 63 66 74
Alcohol use problem 38 45 35 40 43
Drug use problem 26 35 23 31 32
Mental health problem 39 44 38 37 46
HIV/AIDS 3 2 3 2 5
Veteran 23 27 20 22 23

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Street locations include any place not meant for habitation (e.g., transportation sites, places of business, vehicles, abandoned buildings, anywhere outside, etc.). Shelters include emergency shelters, transitional housing programs, and vouchers for temporary shelter. Other programs include permanent housing programs for formerly homeless people, food pantries, outreach programs, drop-in centers, and other programs.


Income, Employment, and Other Income Sources

Income

The average income of homeless clients during the month before being interviewed was $367 (table 2.6).20 Further, 13 percent received no cash income at all during the past month. Clients in families averaged $475, but this amount had to support the parent and two children (on average). Homeless families thus were living on 46 percent of the federal poverty level of $1,023 for a family of three. Single homeless clients averaged $348 during the month before the interview, which was 51 percent of the federal poverty level of $680 a month for a single person. A comparison of these figures with the 1995 median monthly household income of $2,840 for all American households shows just how impoverished homeless clients really are.


Table 2.6
Economic and Other Characteristics of Homeless Clients, by Family Status
  All Homeless Clients Clients in Homeless Families Single Homeless Clients
  (N=2938) (N=465) (N=2473)
Economic Characteristics
Mean Monthly Income ($)a $367 $475 $348
Any Paid Work in Past Month 44(%) 29(%) 46(%)
Any Money from Family/Friendsb 21 32 19
Have Problems Getting Enough Food 58 54 59
Government Benefits
Any Means-Tested Benefits 40 79 39
AFDC 10 52 3
General Assistance 9 10 9
SSI 11 11 11
Food Stamps 37 71 31
Medicaid 30 61 25
Alcohol/Drug/Mental Health Problems
Any ADM Problem Past 30 Days 66 49 69
Alcohol Use Problem 38 18 41
Drug Use Problem 26 20 27
Mental Health Problem 39 36 40

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
aThe standard deviations for the three mean incomes are $354, $342, and $353, respectively.
bIncludes spouse, parents, other relatives, friends (including boyfriends and girlfriends), and child support.


Paid Employment

Almost half (44 percent) of homeless clients did some paid work during the 30 days before being interviewed, and 21 percent received money from family or friends. Of those who report working in the last 30 days, 20 percent did so in a job lasting or expected to last at least three months, 25 percent worked at a temporary or day labor job, and 2 percent earned money by peddling or selling personal belongings. Three percent name more than one source of earned income. Of those receiving money from family members or friends, 9 percent receive it from parents, 2 percent from a spouse, 5 percent from other relatives, 12 percent from friends, including boyfriends and girlfriends, and 1 percent from child support. Eight percent receive income from more than one type of friend or family member. Eight percent report obtaining money through panhandling. Considerably fewer (29 percent) homeless clients in families did any paid work. On the other hand, homeless clients in families were more likely than other homeless clients to receive money from family members or friends (32 versus 19 percent), including spouses, other relatives, friends including boyfriends and girlfriends, and child support. However, this help was clearly not enough to supply an adequate income.

Receipt of Government Benefits

Homeless clients receive income from a variety of sources in addition to earning income through a job. Means-tested government sources of income include AFDC (52 percent of homeless families), GA (9 percent), and SSI (11 percent). Food stamps was the government benefit helping the largest proportion of homeless clients (37 percent), followed by Medicaid (30 percent).

Receipt of means-tested benefits differs considerably by family status (figure 2.14). As would be expected, 52 percent of homeless families receive AFDC. In addition, homeless clients living in families are much more likely than single homeless clients to receive food stamps (61 versus 25 percent), and Medicaid (71 versus 31 percent). Although the two groups do not differ in their receipt of General Assistance or SSI, the difference attributable to the three programs linked through AFDC (AFDC, food stamps, and Medicaid) is enough to raise the level of homeless families receiving any means-tested benefit to 79 percent, compared with half of that (39 percent) among single homeless clients.

Figure 2.14

History of Homelessness

For almost half (49 percent) of homeless clients, their current spell of homelessness is their first (table 2.7). Of the remaining homeless clients, 17 percent are in their second spell and 34 percent have had at least three homeless spells including the current one. Twenty-eight percent of current episodes have lasted three months or less, another 11 percent have lasted between four and six months, 15 percent between seven and twelve months, 16 percent between thirteen and twenty-four months, and 30 percent have lasted two years or more.

Patterns of homelessness differ between homeless clients in families and single clients, primarily among those who are in their first homeless episode (figure 2.15). Both groups are equally likely to be in a first episode (50 and 49 percent). However, homeless families are more likely than single homeless clients to be in a short first episode (34 versus 15 percent), and less likely to be in a long first episode (16 versus 34 percent).

Homeless clients give many different reasons why they had to leave their last residence, but only a few reasons are identified by at least 5 percent of clients. These include not being able to pay the rent (15 percent), losing a job or having a job end (14 percent), doing drugs (7 percent), the landlord making one leave (6 percent), and not getting along with the people there (5 percent). Reasons for leaving one's last residence differ greatly by family status. More homeless clients in families than single homeless clients left because they could not pay the rent (22 versus 14 percent), because there was violence in the household (13 versus 2 percent), or because the landlord made them leave (12 versus 5 percent). Conversely, fewer homeless clients in families than single homeless clients say they left because they lost their job (2 versus 16 percent).


Table 2.7
History of Homelessness and Transiency, by Family Status
  All Homeless Clients Clients in Homeless Families Single Homeless Clients
  (N=2938) (N=465) (N=2473)
Number of Times Homeless
One 49(%) 50(%) 49(%)
Two 17 27 15
Three or more 34 23 37
Length of Current Homeless Period
<3 months 28 49 23
4-6 months 11 11 11
7-12 months 15 16 15
13-24 months 16 11 17
25+ months 30 13 34
Pattern of Homelessness
First time homeless
6 months or less 18 34 15
more than 6 months 31 16 34
Not first time homeless      
current spell 6 months or less 21 26 20
current spell more than 6 months 30 25 31
Things Mentioned Most Frequently as Primary Reasons for Leaving Last Residence
Couldn't pay the rent 15 22 14
Lost job or job ended 14 2 16
Was doing drugs 7 4 7
Landlord made me leave 6 12 5
Didn't get along with the people there 5 3 5
Client or child abused/violence in household 4 13 2
When Homeless, Number of Towns/Cities Where Stayed 2 or More Days
1 (the location where they were interviewed) 56 71 54
2 22 16 23
3 8 10 8
4 3 2 3
5 to 10 6 1 6
11 or more 5 * 6
Clients Reporting a Move from One Community to Another While Homeless
  44 29 46
Among Movers, Where Living Now versus When First Became Homeless
In same state 61 74 59
In different state 37 26 39
In different country 1 0 2
Among movers, reasons left city/town where became homeless
No jobs available 18 10 19
Evicted/asked to leave housing 14 20 13
No affordable housing available 13 18 12
No services available 5 13 4
Among movers, reasons came to this city/town
Had friends/relatives here 25 29 24
Availability shelters/missions 21 41 18
Availability good services/programs 19 27 17
To look for work, heard were jobs 16 16 16

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100 percent due to rounding.
* Denotes percentage less than 0.5 percent but greater than 0.


People Who Change Locations after Becoming Homeless

Fifty-six percent of homeless clients were interviewed in the same city, town, or rural community where they became homeless this time; that is, they have not changed communities since becoming homeless (table 2.7). An additional 22 percent say they have stayed for at least two days in two different communities since becoming homeless (including the one where they were interviewed), 8 percent have stayed in three different communities, and 14 percent have stayed in four or more different communities since becoming homeless. Among movers, 61 percent moved from one community to another within the same state, with 74 percent of homeless families and 59 percent of single homeless clients who moved staying within the same state.

Family status makes a big difference in the likelihood of moving from one community to another while homeless. Homeless clients in families were much more likely to have remained in the same community than were single homeless clients (71 versus 54 percent). In addition, they were much less likely to have stayed in five or more communities while homeless (1 versus 12 percent).

Figure 2.15

Why They Move. Respondents who report having left the community where this episode of homelessness began explained why they left that place, and why they came to the city or town where they were interviewed for NSHAPC. Many reasons were given for leaving their original town. The four most common were that there were no jobs in that place (18 percent), there was no affordable housing in that place (13 percent), they were evicted or asked to leave their housing (14 percent), and there were no services in that place (5 percent). Clients in families were less likely than single homeless clients to give lack of jobs as a reason for leaving (10 versus 19 percent), and more likely to give as reasons the lack of affordable housing (18 versus 12 percent), eviction/being asked to leave (20 versus 13 percent), and perceived lack of services (13 versus 4 percent).

Homeless clients who moved also gave many reasons for coming to the city or town where they participated in NSHAPC. Only four reasons were given by 10 percent or more of movers: they had friends and/or relatives here (25 percent), shelters/missions were here (21 percent), they were looking for work or heard there were jobs here (16 percent), and there were good services and programs here (19 percent). Only the two service-related reasons differentiate families from single homeless clients. Forty-one percent of families who moved mentioned the availability of shelters or missions in their new location, compared with 18 percent of single homeless who moved, while 27 percent of families who moved mentioned good services or programs as a reason to come to their current location, compared with 17 percent of single homeless clients who moved.

Where They Move from and Where They Move to. The basic pattern of moves between community types is for people to move to a place that is larger than the one they came from.21 Among people who changed the type of community in which they were living after becoming homeless for their current episode, 28 percent started in a large central city, 14 percent in a medium-sized central city, 31 and 10 percent, respectively, in the urban fringes of large and medium-sized central cities, 10 percent in large or small towns, 5 percent in rural areas, and 1 percent in another country (table 2.8).


Table 2.8
Movers: Origins and Destinations
  Locations Where Client Became Homeless, This Episodea
  Large Central City (28%) Medium Central City (14%) Urban Fringe of Large Central City (31%) Urban Fringe of Medium Central City (10%) Large Town (3%) Small Town (7%) Rural (5%) Another Country (1%)
Moved Within Same Type of Place 66 49 50 27 0 0 1 0
Moved to Different Type of Place   51 50 73 100 100 99 100
What Type of Place Did They Move To?                
Large central city NA 40 34 25 44 22 27 Insufficient
Medium-sized central city 20 NA 14 47 55 38 60 N
Urban fringe of large central city 14 8 NA 1 * 41 3  
Urban fringe of medium-sized central city * 4 1 NA 1 0 10  
Large town, small town, or rural location 0 0 1 0 0 0 0  

Source: Urban Institute analysis of weighted 1996 NSHAPC Client data.
Note: Percentages do not sum to the proportion who moved to a different type of place due to rounding.
* Denotes values that are less than .5 percent but greater than 0. Unweighted N of movers with usable answers= 1357.
NA = Not Applicable.
a Percentage in parentheses are the proportion of movers who originated in each venue.


Comparisons of Clients from Central Cities, Suburbs, and Rural Areas

Among all homeless clients, 71 percent were interviewed in central cities, 21 percent in suburban areas, and 9 percent in rural areas (table 2.9). This distribution does not vary by whether or not the client is in a family household, nor would it change if one included the children as well as their parents in the analysis. Homeless clients are thus much more likely to live in central cities than the U.S. poor population, 41 percent of whom live in central cities, 35 percent in the suburbs and urban fringe areas, and 23 percent in rural areas outside of metropolitan statistical areas (figure 2.16).

Central city and rural clients do not differ in their sex distribution (71 and 77 percent male), but suburban clients are significantly less likely to be male (55 percent). Suburban clients are also more likely to be white non-Hispanics (54 percent) than clients from either central cities (37 percent) or rural areas (42 percent).

In general, rural homeless clients have experienced fewer and shorter episodes of homelessness during their lifetimes. Fifty-five percent of rural clients have been homeless for three months or less, compared with 22 to 27 percent of central city and suburban homeless clients. In addition, only 27 percent have been homeless for more than a year, compared with 48 percent of central city and 49 percent of suburban clients.


Table 2.9
Characteristics of Homeless Clients in Central Cities, Suburbs, and Rural Areas
  Homeless Clients
  Clients in Central Cities Clients in Suburban/Urban Fringe Areas Clients in Rural Areas
  (N=2295) (N=410) (N=269)
Proportion of Currently Homeless 71 21 9
Gender
Male 71 55 77
Female 29 45 23
Race/Ethnicity
White non-Hispanic 37 54 42
Black non-Hispanic 46 33 9
Hispanic 11 11 7
Native American 5 1 41
Other 1 1 *
Age
Less than 25 13 12 7
25-54 79 77 88
55 and older 8 11 5
Family Status--With Own Child 14 16 17
Economic Characteristics
Mean Monthly Income ($) $341 $422 $449
Median Monthly Income ($) $250 $395 $475
Length of Current Homeless Episode
3 months or less 27 22 55
more than 12 months 48 49 27
Alcohol/Drug/Mental Health Problems
Any ADM Problem Past 30 Days 67 64 67
Alcohol Use Problem 39 30 48
Drug Use Problem 28 24 15
Mental Health Problem 41 37 26
Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100 percent due to rounding.
*Denotes percentage less than 0.5 but greater than 0 percent.


A larger proportion of central city clients (21 percent) report staying in places not meant for habitation than is true for suburban (12 percent) or rural clients (4 percent). Clients from central cities are more likely than those from suburban/urban fringe and rural areas to have used a soup kitchen (68 percent, 50 percent, and 45 percent, respectively) and a drop-in center in their lifetime (30 percent, 18 percent, and 14 percent, respectively). The lack of availability of these programs outside of central cities most likely affects these results.

Central city homeless clients are considerably poorer than other homeless clients. Clients' median income is $250 in central cities, $395 in suburban areas, and $475 in rural areas. Fifteen percent of central city clients report no income over the last 30 days compared with only 6 to 7 percent of other clients.

Rural homeless clients report less access to medical care. Forty-seven percent of rural clients say they needed to see a doctor or nurse in the last year but were not able to do so, compared with 22 percent of homeless clients in both central cities and suburban/urban fringe areas.

Similar proportions (64 to 68 percent) of central city, suburban, and rural clients have a current mental health and/or alcohol and/or drug problem. However, clients from central cities are more likely (25 percent) than those in suburban areas (17 percent) to have current problems with both mental health and alcohol and/or drug use. And clients in both central cities and suburban areas are more likely than rural clients (11 percent) to have such problems.

Thirty-three percent of suburban homeless clients, 24 percent of those from central cities, and 12 percent of those from rural areas report being physically or sexually abused before the age of 18. Incarceration follows the opposite pattern, with the suburbs lowest and rural areas highest. Sixty-four percent of clients from rural areas have spent time in juvenile detention, jail, or state or federal prison, compared with 55 percent of those from central cities and 44 percent from suburban areas.

Figure 2.16

Comparisons with 1987 Urban Institute Findings

In 1987 the Urban Institute conducted a national survey of homeless clients using shelters and soup kitchens in large U.S. cities (those with 100,000 or more population in 1994). As there is considerable interest in examining whether, and in what ways, clients who are homeless may have changed during the nine years between the Urban Institute and NSHAPC surveys, relevant comparisons are presented here. For this analysis NSHAPC data have been restricted to be comparable to the 1987 data. This means that the 1996 statistics in this comparison are based only on homeless NSHAPC clients found in central cities who were sampled from shelters, voucher distribution programs, and soup kitchens. Table 2.10 presents comparable figures for 1987 and 1996 using these parameters to analyze the 1996 NSHAPC data.

As can be seen from the data in table 2.10, in 1996 homeless shelter and soup kitchen users located in central cities are less likely to be white (39 versus 46 percent) and more likely to be black (46 versus 41 percent) than those from 1987. They are more likely to have completed high school—39 versus 32 percent, and to have some education beyond high school—27 versus 20 percent. They are more likely to have married at some time in their lives (51 versus 45 percent), but have the same likelihood of being in a homeless family (10 percent in each year).

Although the mean length of clients' current homeless episode is shorter in 1996 than it was in 1987 (39 versus 32 months), there is no significant difference in the median length (12 versus 10 months).22 There is some increase in the proportion with short spells (30 versus 21 percent with spells of three months or less). However, there is no change in the proportion with long spells (31 percent of both 1987 Urban Institute and comparable 1996 NSHAPC clients reported spells of two or more years' duration).

In 1996, a larger proportion of homeless households received means-tested benefits (AFDC, SSI, and food stamps) than was true in 1987. In 1987, 33 percent of homeless clients in families reported receiving AFDC, which increased to 58 percent of comparable NSHAPC clients in 1996. Twice as large a proportion of all homeless central city users of shelters and soup kitchens received food stamps in 1996 compared with 1987 (37 percent versus 18 percent). For SSI the figures tripled (13 versus 4 percent). These differences are probably attributable to significantly greater efforts by homeless service providers to help clients obtain benefits, and to greater outreach efforts on the part of the government benefit programs themselves. Major SSI rule changes that effectively reduced the eligibility of many clients at high risk for homelessness (by eliminating eligibility for clients with a primary diagnosis of alcohol and/or drug abuse) did not take effect until after NSHAPC data were collected.

Probably as a consequence of increased access to public benefits, mean monthly per person income is higher in 1996 ($267) than it was in 1987 ($189)23 among comparable clients. These estimates assume that the 10 percent of clients who have children with them have on average two children each, and that the remaining 90 percent of clients are by themselves.

The food situation has improved somewhat for homeless clients. In 1987, 38 percent of clients in the Urban Institute study (homeless users of central city shelters and soup kitchens) said they sometimes or often did not get enough to eat. Among comparable NSHAPC clients, 28 percent say the same in 1996. The greater likelihood of receiving food stamps may be related to this improved food situation. In addition, 31 percent say they get enough of the kinds of food they want to eat, compared with 19 percent in 1987.

The proportion of central city homeless clients who have experienced inpatient treatment for alcohol or drug abuse or for mental health problems has not changed at all between 1987 and 1996. The statistics in this analysis are based on all central city homeless clients, rather than being restricted to those who have any alcohol, drug, or mental health problem, because the 1987 Urban Institute data do not include the information needed to assess service use only among those with a problem.

Table 2.10
What Has Changed? Comparing Homeless Clients Found in Central City Shelters and Soup Kitchen in 1987 and 1996
  1987
(N=1704)
1996
(N=1472)
Sex—Percent Male 81% 79%
Race/Ethnicity
White non-Hispanic 46a 39
Black non-Hispanic 41 46
Hispanic 10 11
Other 3 4
Education
Less than 12 grade 48 34
Completed 12 grade 32 39
More than 12 grade 20 27
Relationship/Household Status
Never Married 55 49
Homeless family 10 10
Length of Current Homeless Spell
Mean (in months) 39 months 32 months
Median (in months) 10 months 12 months
Three months or less 21(%) 30(%)
2 years or more 31 31
Receipt of Public Benefits
AFDC (households with children only) 33 58
SSI 4 31
Food Stamps 18 37
Mean Monthly Income per Person $189b $267
Sometimes or Often Don't get Enough to Eat 38(%) 28(%)
Get Enough of Desired Foods 19 31
ADM Inpatient Treatmentc
Inpatient alcohol and/or drug treatment only 24 22
Mental hospitalization only 10 10
Both 9 12
Neither 57 56

Source: 1987 statistics from Burt and Cohen, 1989; 1996 statistics based on special runs, with modified weights, of NSHAPC clients who match the criteris used in 1987 (central city, currently homeless, found in shelters and soup kitchen).
aWithin rows, statistics in bold are significantly different from each other at p=.10.
bThis 1987 figure has been adjusted for inflation to 1996 dollars using CPI-U; figures for both years assume three people per family household and one person for all other households.
cBased on all clients, because no variables exist in the 1987 database from which to determine the existence of a qualifying condition/problem.



3 Comparing Currently with Formerly Homeless Clients and Other Service Users


HIGHLIGHTS

Comparing Currently with Formerly Homeless Clients and Other Service Users 1
  • Fifty-four percent of NSHAPC clients are homeless, 22 percent are formerly homeless, and 24 percent are other service users who have never been homeless.
  • Men and women figure very differently in the three subpopulations of clients. Men comprise 68 percent of currently homeless clients compared with 54 percent of formerly homeless clients. Among other service users, 39 percent are men.
  • There are no significant racial differences between currently and formerly homeless clients. Equivalent proportions are white non-Hispanic (41 and 46 percent), black non-Hispanic (40 and 41 percent), Hispanic (11 and 9 percent), Native American (8 and 2 percent) and other races (1 and 2 percent). Among other service users, 54 percent are white non-Hispanic, 41 percent are black non-Hispanic, 11 percent are Hispanic, and 1 percent each are Native American and other races.
  • Young clients (ages 17 to 24) make up a greater share of currently than formerly homeless clients (12 versus 6 percent). The age group of 25- to 34-year-olds is also more common among currently than formerly homeless clients (25 versus 16 percent). The opposite is true as age increases; 45- to 54-year-olds as well as those ages 55 and older are more numerous among formerly than currently homeless clients.
  • Currently homeless clients are more likely than formerly homeless clients to report needing help finding a job (42 versus 30 percent), help finding affordable housing (38 versus 21 percent), and assistance with rent, mortgage, or utilities for securing permanent housing. Formerly homeless clients are more likely than currently homeless clients to report needing help to obtain food (32 versus 17 percent). Among other service users, help obtaining food and help with other issues are their most important needs.
  • Currently and formerly homeless clients are more than twice as likely as poor U.S. households who are not homeless to say they sometimes or often do not get enough to eat (28 and 25 percent versus 12 percent). Other service users do not differ on this dimension from nonhomeless poor clients (16 versus 12 percent).
  • Currently and formerly homeless clients are alike in their reported level of acute infectious conditions (26 and 28 percent) and acute noninfectious conditions (8 and 6 percent). However, formerly homeless clients have more chronic health conditions than do currently homeless clients (62 versus 46 percent). Other service users are quite likely to report chronic health conditions (67 percent).
  • Over half (55 percent) of currently homeless clients have no health insurance, compared with 32 percent of formerly homeless clients. More formerly homeless clients than currently homeless clients receive Medicaid (53 versus 30 percent). Forty-three percent of other service users receive Medicaid, 28 percent have "other" insurance, and 31 percent have no insurance.
  • In general, currently homeless clients have higher rates than formerly homeless clients of alcohol and drug problems in the past month, past year, and lifetime. Currently and formerly homeless clients report similar rates of mental health problems regardless of time period. As the time period increases, the proportion of clients reporting problems in these areas increases. Other service users have the lowest rates of any group, for every time period.
  • More currently than formerly homeless clients report having spent time in a state or federal prison (18 versus 9 percent) or in juvenile detention before they reached the age of 18 (16 versus 9 percent). Four percent of other service users had spent time in either venue.
  • Twenty-five percent of currently homeless clients began drinking before age 15, and 18 percent first started using drugs at this young age. Both of these rates are higher than those for formerly homeless clients (19 percent for drinking and 13 percent for using drugs). Six percent of other service users started drinking before age 15, and 4 percent started using drugs before that age.
  • Twenty-five percent of currently homeless clients report being physically and/or sexually abused by a household member before reaching their 18th birthday. Their rate of childhood abuse is similar to that of formerly homeless clients (at 22 percent). Other service users report an abuse rate of 6 percent before reaching the age of 18.
  • More currently than formerly homeless clients (27 and 19 percent, respectively) were placed in foster care, a group home, or other out-of-home placement. Similar proportions of both groups had been forced to leave home for more than 24 hours (22 and 19 percent, respectively). The two groups differ in the proportion who had run away from home for more than 24 hours (33 versus 27 percent) and had a homeless experience before the age of 18 (21 versus 12 percent).
  • Currently homeless clients are the poorest. Their mean income during the last 30 days is $367, compared with a mean income of $469 among formerly homeless clients during the past 30 days. These figures are significantly lower than the 1996 federal poverty level of $680 a month for a single person. Other service users also have a mean income, at $575 during the last 30 days, that indicates that even other service users are very poor.
  • Food stamps are the most common type of government benefit for currently and formerly homeless clients, but formerly homeless clients are more likely than currently homeless clients to receive them (48 versus 37 percent). Currently homeless clients are less likely than formerly homeless clients to receive SSI (11 versus 29 percent) and General Assistance (9 versus 16 percent). Food stamps (at 37 percent), Social Security (at 33 percent), and General Assistance (at 26 percent) are the most common income sources for other service users.
  • Currently homeless clients are more likely than formerly homeless clients to have had only one homeless episode (49 versus 40 percent). No difference exists in the proportion of currently and formerly homeless clients who have been homeless four or more times (21 to 22 percent).
  • Currently homeless clients are more likely than formerly homeless clients to have been interviewed in central cities (71 versus 64 percent), and less likely to have been interviewed in rural areas (9 versus 19 percent). Other service users are equally likely to have been interviewed in rural areas (40 percent) and central cities (39 percent).


Introduction

NSHAPC was designed to include interviews with all users of homeless assistance programs, including those who are not homeless. Information about nonhomeless clients helps in understanding who else is using these programs, and what experiences they may have with homelessness. In looking at results presented in this chapter that compare these groups, readers should be aware of some important limitations of NSHAPC data that limit simple inferences of causality. Formerly homeless clients and other service users in the NSHAPC sample are a random and representative sample of formerly and never homeless users of NSHAPC homeless assistance programs, but are not a representative sample of all formerly and never homeless clients in the United States.2

As will be seen, many similarities exist between currently and formerly homeless clients of NSHAPC homeless assistance programs (see chapter 1 for how these groups are defined). These similarities suggest two things, at least. First, some proportion of clients classified as formerly homeless by NSHAPC are essentially the same as currently homeless clients with a history of episodic homelessness, and the survey caught some in a homeless phase and others in a housed phase. Second, however, it is clear that some proportion of formerly homeless clients have been helped to leave homelessness through the auspices of public benefits and/or permanent housing programs. Because eligibility for these programs usually requires some level of disability (especially for programs that are federally funded), the inclusion of permanent housing program residents raises the level of reported health and other problems of NSHAPC's formerly homeless group.

Other users of homeless assistance programs are also of interest to service providers and policymakers. Although housed, their poverty is sufficient to bring them to homeless assistance programs for help, usually with food (75 percent were found in food programs, including soup kitchens, food pantries, and mobile food programs).

Basic Demographic Characteristics

Basic demographic characteristics for currently and formerly homeless clients and other service users are presented in table 3.1.



Figure 3.1


Sex

Men and women figure very differently in the three subpopulations of clients (figure 3.1). Men comprise 68 percent of currently homeless clients compared with 54 percent of formerly homeless clients. Among other service users 39 percent are men and 61 percent are women. Only the sex distribution of formerly homeless clients resembles that of the U.S. adult population, which was 48 percent male and 52 percent female in 1996 (Bureau of the Census 1997, table 14).


Table 3.1
Basic Demographic Characteristics, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518) U. S. Adult Population (1996)
Sex        
Male 68(%) 54(%) 39(%) 48(%)a
Female 32 46 61 52
Race/Ethnicity
White non-Hispanic 41 46 54 76b
Black non-Hispanic 40 41 32 11
Hispanic 11 9 11 9
Native American 8 2 1 1
Other 1 2 1 3
Age
Under 18 1 0 1 Not Applicable
18 to 21 yrs. 6 2 4 7c
22 to 24 yrs. 5 2 5 5
25 to 34 yrs. 25 17 12 21
35 to 44 yrs. 38 36 18 22
45 to 54 yrs. 17 26 16 17
55 to 64 yrs. 6 11 16 11
65 or more yrs. 2 6 29 17
Education/Highest Level of Completed Schooling
Less than High School 38 42 49 18d
High School Graduate/G.E.D. 34 34 32 34
More than High School 28 24 19 48
Marital Status
Never Married 48 45 28 23e
Married 9 9 22 60
Separated 15 14 10 f
Divorced 24 25 15 10
Widowed 3 6 25 7
Living Situation
Respondent 24 or younger
With own child <18
Men * * * Not Available
Women 3 1 4  
Other respondents
Men 5 2 2  
Women 4 1 2  
Respondent 25 or older        
With own child <18
Men 2 3 2  
Women 9 13 14  
Other respondents        
Men 62 50 34  
Women 16 30 42  
Veteran Status 23 22 14 13g

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100 percent due to rounding.
*Denotes values that are less than 0.5 percent by greater than 0.
Sources for U.S. adult population data:
a Bureau of the Census (1997a), data for 1996; table 14, N = 200 million.
b Ibid., table 23, N = 196.2 million.
c Ibid., table 16, N = 196.2 million.
d Ibid., table 245, N = 168.3 million persons ages 25 and older.
e Ibid., table 58, N = 193.2 million.
f Included in "married." gDepartment of Veterans Affairs, data for 1995.



Race/Ethnicity

There are no significant racial differences between currently and formerly homeless clients. Equivalent proportions are white non-Hispanic (41 and 46 percent), black non-Hispanic (40 and 41 percent), Hispanic (11 and 9 percent), Native American (8 and 2 percent) and other races (1 and 2 percent). Among other service users, 54 percent are white non-Hispanic, 32 percent are black non-Hispanic, 11 percent are Hispanic, and 1 percent each are Native American and other races. However, all groups are significantly less likely to be white non-Hispanics than the U.S. population as a whole (76 percent), and more likely to be black non-Hispanics (40, 41, and 32 percent versus 11 percent) (Bureau of the Census 1997a, table 23).

Age

Young clients (ages 17 to 24) make up a greater share of currently than formerly homeless clients (12 versus 4 percent) (figure 3.2). The age group of 25- to 34-year-olds is also more common among currently than formerly homeless clients (25 versus 17 percent). The opposite is true as age increases; 45- to 54-year-olds as well as those ages 55 and older are more numerous among formerly than currently homeless clients. Sixty-one percent of other service users are ages 45 and older, with 29 percent being ages 65 and older.



Figure 3.2

Education

No differences exist in the educational attainment of currently and formerly homeless clients. Thirty-four percent of each group are high school graduates or have a G.E.D., with 28 and 24 percent, respectively, having some education beyond high school. About half of other service users (49 percent) have not completed high school, 32 percent have high school diplomas, and 19 percent have some education beyond high school. All three groups are similar in their proportion of high school graduates compared with the U.S. adult population as a whole (at 34 percent). But all U.S. adults are significantly more likely than any group of NSHAPC clients to have some education beyond high school (48 percent) (Bureau of the Census 1997a, table 245).

Marital and Household Status

Similar proportions of currently and formerly homeless clients have never married (48 and 45 percent), divorced (24 and 25 percent), and separated (15 and 14 percent). In addition, equal proportions are married (9 percent in each group) and widowed (3 and 6 percent). Among other service users, 28 percent have never married, 22 percent are currently married, 25 percent are widowed (reflecting their high proportion of older women), 10 percent are separated, and 15 percent are divorced.

Information about whether or not a client lives in a family was combined with information about the client's age and sex to describe as best as possible the client's household status. The results are reported in table 3.1.

Among clients ages 17 to 24, about one-fourth of currently homeless clients (3 of 12 percent) and one-sixth of formerly homeless clients (1 of 6 percent) are women living in families. Currently homeless clients are more likely than formerly homeless clients to be single men ages 25 and older (61 versus 49 percent). Ten percent of other service users are ages 17 to 24, among whom 4 in 10 are women living in families. Sixteen percent of other service users are clients ages 25 and older living in families. Single clients ages 25 and older comprise 74 percent of other service users; 33 percent are men and 41 percent are women.

Veteran Status

The proportion of currently and formerly homeless clients who are veterans is similar (23 and 22 percent, respectively). Among other service users the proportion is 14 percent. The Department of Veterans Affairs estimates that in 1995, 13 percent of all American adults were veterans.

Service Needs, Stresses, and Vulnerabilities

Service Needs as Seen by Clients

Each client was asked to select from an extensive list of various needs "the three things you need the most help with now." Responses are reported in table 3.2.

Currently compared with formerly homeless clients are more likely to report needing help finding a job (42 versus 30 percent), help finding affordable housing (38 versus 21 percent), and assistance with rent, mortgage, or utility payments for securing permanent housing (30 versus 15 percent). Formerly homeless clients are more likely to say they need help obtaining food (32 percent, compared with 17 percent for currently homeless clients). Among other service users, the highest service needs are for help obtaining food (33 percent), and other needs (31 percent).

"Other" needs were mentioned by almost one-third of other service users, and by one-fourth of currently and formerly homeless clients. Small proportions mentioned needing help with getting clothing, transportation, legal aid, medical or dental care for themselves or their children, drug/alcohol/mental health treatment, enrolling children in school, and domestic violence, in addition to assistance with job training and managing money. Also many clients mentioned an "other" need that was personal, such as "a good man/woman," "spiritual growth," and "peace of mind." All of these responses are included in the "other" response category.

Table 3.2
Service Needs, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518)
Five Top Responses Clients Provided to "What Are the (Three) Things You Need the Most Now?"
Finding a job 42(%) 30(%) 22(%)
Finding affordable housing 38 21 14
Assistance with rent, mortgage, or utilities for securing permanent housing 30 15 5
Othera 24 25 31
Transportation assistance 19 17 14

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers may not sum to 100 percent due to rounding.
a"Other" was an actual answer category chosen by many clients and does not include assistance getting clothing, food, legal aid, medical/dental care (for self or children), drug/alcohol/mental health treatment, assistance with parenting, child care services and cost, enrolling children in school, domestic violence, educational issues, money management, job training, or conflict resolution.

Food Consumption and Hunger

Clients reported whether they (1) get enough of the kinds of foods they want; (2) get enough but not always the kinds of foods they want; (3) sometimes do not get enough food to eat; and (4) often do not get enough food to eat. Currently and formerly homeless clients report a similar likelihood (28 and 25 percent) of sometimes or often not getting enough to eat (table 3.3). This likelihood is much higher than the likelihood of having similar difficulties among all U.S. households (4 percent) and even among all poor households in the country (12 percent).3

Currently and formerly homeless clients are equally likely to report two or more problems getting enough food (38 and 31 percent). Thirteen percent of other service users report this level of problems getting enough food. Individual problems over the past 30 days included in this index are eating once a day or less, being hungry but not having money for food, and going a whole day without eating because of not having money for food. Similar proportions of currently and formerly homeless clients report eating once a day or less (20 and 17 percent). Currently homeless clients are more likely than formerly homeless clients to report the other two measures (39 versus 26 percent for "hungry but not enough money for food," and 40 versus 33 percent for "whole day without eating"). Both are much higher than parallel figures for all U.S. households (2 and 1 percent, respectively) and poor U.S. households (5 and 3 percent, respectively).

Other service users report some level of difficulty getting enough food. Sixteen percent report sometimes or often not getting enough to eat, and 13 percent report two or more food-related problems. Specific problems reported for the past 30 days include 10 percent who report eating once a day or less, 11 percent who were hungry but did not have enough money for food (compared to 5 percent of poor U.S. households), and 17 percent who went a whole day without eating because they could not afford food (compared to 3 percent of all U.S. households). Thus other service users also have more problems getting adequate food than do poor U.S. households.

Table 3.3
Food Consumption and Hunger, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518) All U.S. Households below the Poverty Level (1995)a All U.S. Householdsb
Best Description of Food Situation
Get enough of kinds of food wanted 39(%) 37(%) 50(%) 60(%)d 80(%)b
Get enough, but not always what is wanted 33 38 34 29 16
Sometimes not enough to eat 18 15 14 9 3
Often not enough to eat 10 10 2 3 1
Current Food Problems
None 42 48 66 NA NA
One 20 22 21    
Two 17 18 8    
Three 13 8 4    
Four 8 5 1    
Eats Once a Day or Less 20 17 10 NA NA
In Last 30 Days, Hungry but Not Enough Money for Food 39 26 11 5e 2c
In Last 30 Days, Went at Least One Whole Day without Eating 40 33 17 3e 1b

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100 percent due to rounding.
aData for U.S. households and U.S. households below the poverty level taken from the Current Population Survey Food Security Supplement, April 1995, table 1 (Food and Consumer Service 1999).
bN associated with these data is 5,480. cN associated with these data is 44,651. dN associated with these data is 877. eN associated with these data is 6,653.


Physical Health Status and Insurance

Survey clients were asked about 17 medical conditions, classified subsequently as acute infectious conditions (chest infection/cold/cough/bronchitis, pneumonia, tuberculosis, STDs other than AIDS); acute noninfectious conditions (skin diseases, lice/scabies); chronic health conditions (diabetes, anemia, high blood pressure, heart disease/stroke, liver problems, arthritis/ rheumatism, cancer, problems walking/other handicap, HIV/ AIDS); whether they used drugs intravenously; and other medical problems.

Currently and formerly homeless clients report the same levels of acute infectious or acute noninfectious conditions. However, formerly homeless clients report higher rates of chronic health conditions than do currently homeless clients (62 versus 46 percent). Two-thirds of other service users report chronic conditions, 29 percent report acute infectious conditions, and 3 percent report the acute noninfectious conditions about which the survey asked (table 3.4).

The most common conditions among all groups are arthritis, rheumatism, and joint problems, although at quite different levels. Currently homeless clients are less likely to report these chronic conditions than are formerly homeless clients (24 versus 37 percent). Currently homeless clients are also less likely than formerly homeless clients to report high blood pressure (15 versus 22 percent), and problems walking or other physical handicap (14 versus 22 percent). Among other service users the rate for arthritis and similar problems is 42 percent, high blood presssure is 33 percent, problems walking/other handicap is 30 percent, and upper respiratory problems is 27 percent.

Table 3.4
Physical Health Status, by Homeless Status
  Currently Homeless Clients (N=2398) Formerly Homeless Clients (N=677) Other Service Users (N=518)
Reported Health Problemsa
Acute infectious conditions (one or more) 26(%) 28(%) 29(%)
Acute noninfectious conditions (one or more) 8 6 3
Chronic conditions (one or more) 46 62 67
Four Most Common Medical Conditons
Arhritis, rheumatism, joint problems 24 37 42
Chest infection, cold, cough, bronchitis 22 24 27
Problem walking, lost limb, other handicap 14 22 30
High blood pressure 15 22 33
Needed but Not Able to See Doctor or Nurse in Last Year
Type of Medical Insuranceb
Medicaid 30 53 43
VA medical care 7 6 3
Private insurance 4 5 13
No insurance 55 32 31
Other 10 11 28
Among Clients in Families (N=465) (N=117) (N=126)
Children Needed but Not Able to See Doctor or Nurse in Last Year 8 9 9
Children's Medical Insuranceb
Medicaid 73 74 61
Private Insurance 6 7 11
No insurance 20 14 20
Other 6 5 10

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100 percent due to rounding or because clients choose more than one answer.
aSurvey clients were asked about 17 medical conditions, classified subsequently as acute infectious conditions (chest infection/cold/cough/bronchitis, pneumonia, tuberculosis, STDs other than AIDS); acute noninfectious conditions (skin diseases, lic/scabies); chornic health conditions (diabeties, anemia, high blood pressure, heart disease/stroke, liver problems, arthritis/rhemuatism, cancer, problems walking/other problem, HIV/AIDS); other; and whether they used drugs intravenously.
bClients could name more than one type of insurance.

Similar proportions of currently and formerly homeless clients (24 and 26 percent) needed but were unable to see a doctor in the year prior to the survey (figure 3.3). This figure is much lower among other service users (12 percent). Far fewer of the children living with clients were affected by this lack of access to care, with similar proportions (8 and 9 percent) of parents in each subgroup reporting any problems with access for their children.

Coverage by health insurance varies considerably by homeless status (figure 3.4). Clients could report more than one type of insurance, so figures do not sum to 100 percent. Over half (55 percent) of currently homeless clients have no health insurance, compared with 32 percent of formerly homeless clients. More formerly homeless clients than currently homeless clients receive Medicaid (53 versus 30 percent). Other service users report health insurance coverage by Medicaid (43 percent), private insurance (13 percent), other insurance (28 percent), and no insurance (31 percent). The "other" insurance reported by other service users is probably Medicare, given the age of many in this group (28 percent are ages 65 and older).

Figure 3.3

Figure 3.4

Similar proportions (73 and 74 percent) of currently and formerly homeless clients living in families report that their children are covered by Medicaid. (Clients could report more than one type of insurance coverage.) Only 6 to 7 percent of the children living with currently and formerly homeless clients are covered by private insurance. Twenty percent of currently homeless households with children have no health insurance for their children, compared with 14 percent of formerly homeless households with children. These high levels of health insurance coverage for children living with NSHAPC parents help to explain why parents report that relatively few of their children experienced any problems getting needed health care.

Alcohol, Drug, and Mental Health Problems

Measures of alcohol, drug, and mental health (ADM) problems are reported for past month, past year (including past month), and lifetime (including past year). These measures are composites of client reports of behaviors, experiences, and treatment, as defined in chapter 1.

In general, for alcohol and drug problems in all three time frames, currently homeless clients report higher rates than formerly homeless clients. Currently and formerly homeless clients report similar rates of mental health problems in all time periods (table 3.5). Looking at combinations of alcohol, drug, and mental health problems indicates that for relatively recent time periods, currently homeless clients have higher rates of one or more problems during the past month (66 percent) and past year (74 percent) than formerly homeless clients (59 and 66 percent for past month and past year, respectively). However, when the probability of having at least one of these problems over clients' lifetimes is examined, currently and formerly homeless clients are equally likely (86 and 87 percent) to have had at least one of the problems (figure 3.5).

Figure 3.5

Looking at combinations of different problems experienced by the same person, as the time period lengthens from past month to lifetime, more currently and formerly homeless clients report at least one ADM problem (table 3.5). Also, for the longer time periods (past year and lifetime), formerly homeless clients are more likely than currently homeless clients to report only mental health problems (21 versus 15 percent for past year; 17 versus 10 percent for lifetime). Alcohol use problems are more prevalent than drug use problems in each time period for both currently and formerly homeless clients. Alcohol use and mental health problems show the same levels in all time periods for currently homeless clients, but formerly homeless clients report more problems with mental health than with alcohol use for past month (41 versus 29 percent) and past year (46 versus 33 percent). Currently, compared with formerly, homeless clients report higher rates of alcohol use problems during the past month (38 versus 29 percent) and past year (46 versus 33 percent), but are similar over their lifetimes (62 versus 56 percent).

Thirty-one percent of other service users report at least one ADM problem during the past month, 36 percent do so for the past year, and 56 percent do so for lifetime problems. Mental health and alcohol use problems appear in this group at the same levels for past month (16 percent each) and past year (17 and 21 percent), but lifetime alcohol use problems are higher (36 versus 28 percent). Drug use problems are less commonly reported (4 percent for past month, 7 percent for past year, and 18 percent for lifetime).


Table 3.5
Mental Health and Substance Use Problems, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service User (N=518)
Past Month
Alcohol problems 38(%) 29(%) 16(%)
Drug problems 26 17 4
Mental health problems 39 41 16
Specific combinations
Alcohol problem only 13 10 12
Drug problem only 7 4 1
Mental health problem only 17 22 13
Alcohol and drug problems 7 4 1
Alcohol and mental health problems 10 10 2
Drug and mental health problems 5 4 2
Alcohol, drug and mental health problems 8 5 *
No ADM problems 34 41 69
Past Year
Alcohol problems 46 33 17
Drug problems 38 25 7
Mental health problems 45 46 21
Specific combinations
Alcohol problem only 12 10 12
Drug problem only 7 5 2
Mental health problem only 15 21 16
Alcohol and drug problems 10 4 2
Alcohol and mental health problems 10 10 1
Drug and mental health problems 7 7 2
Alcohol, drug, and mental health problems 14 9 2
No ADM problems 26 34 64
Lifetime
Alcohol problems 62 56 36
Drug problems 62 56 36
Mental health problems 57 60 28
Specific combinations
Alcohol problem only 9 8 19
Drug problem only 6 7 3
Mental health problem only 10 17 15
Alcohol and drug problems 15 11 6
Alcohol and mental health problems 9 13 4
Drug and mental health problems 8 7 3
Alcohol, drug and mental health problems 30 24 6
No ADM problems 14 14 44

Source:Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Percentages do not sum to 100 percent due to rounding.
*Denotes values that are less than 0.5 but greater than 0 percent.


Incarceration

Currently and formerly homeless clients are equally likely (49 and 43 percent) to have spent five or more days in a city or county jail, which may be related to their condition of homelessness as well as to other behavior (table 3.6). More currently than formerly homeless clients report having spent time in a state or federal prison (18 versus 9 percent) or in juvenile detention before they reached the age of 18 (16 versus 9 percent). Taking all of their incarceration experiences together, 54 percent of currently homeless clients have spent some time incarcerated, compared with 45 percent of formerly homeless clients. Only 14 percent of other service users have ever been incarcerated.


Table 3.6
History of Incarceration, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518)
History of Time Served
Five or more days in a city or county jail 49(%) 43(%) 13(%)
Five or more days in a military jail/lock-up 4 3 2
State or federal prison 18 9 4
Juvenile detention before age 18 16 9 4
One or more types of incarceration 54 45 14
Never incarcerated 46 55 86

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.


Adverse Childhood Experiences

NSHAPC results indicate that mental health and alcohol and/or drug problems may have roots in the childhood of many clients, as does homelessness itself. Between one-fifth and one-fourth of both currently and formerly homeless clients report that before the age of 18 they (1) started drinking and using drugs; (2) experienced physical abuse, sexual abuse, or both from someone in their household; (3) spent time in juvenile detention; (4) lived in foster care or other out-of-home placement; (5) ran away from or were forced to leave home; or (6) became homeless for the first time (table 3.7).

In general, currently homeless clients are more likely than formerly homeless clients to report initiation of drinking and using drugs at younger ages. Analysis of data from the National Household Survey on Drug Abuse indicates that people who start drinking and using drugs before the age of 15 are at significantly higher risk for problems with substance use as adults (Dennis and McGeary 1998). NSHAPC data indicate that 25 percent of currently homeless clients began drinking before age 15, and that 19 percent first started using drugs at this young age. Both of these rates are higher than those for formerly homeless clients (19 percent for drinking and 13 percent for using drugs) (figure 3.6).

Twenty-five percent of currently homeless clients and a similar proportion of formerly homeless clients (22 percent) report being physically and/or sexually abused by a household member before reaching their 18th birthday (figure 3.6). Rates that combine neglect with abuse experiences show roughly the same pattern, but for this combination currently homeless clients do report significantly higher rates than formerly homeless clients (29 versus 23 percent). Only 8 percent of other service users report any abuse or neglect experience before age 18 (table 3.7).

Finally, 16 percent of currently homeless clients had spent some time in juvenile detention before they reached the age of 18. This proportion is higher than that for formerly homeless clients (at 9 percent). Other service users report a rate of 4 percent for time spent in juvenile corrections institutions. Rates of experiences away from one's childhood family reported by currently and formerly homeless clients are high enough and often similar enough to suggest, as other research has done, that these may be significant risk factors for adult homelessness (e.g., Piliavin, Sosin, and Westerfelt). These questions were not asked of other service users.

Figure 3.6


Table 3.7
Adverse Childhood Experiences, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518)
Substance Use/Justice System Experiences
When first started drinking
Before age 15 25(%) 19(%) 6(%)
Between ages 15 and 17 21 19(%) 15
When first started using drugs
Before age 15 19 13 4
Between ages 15 and 17 19 10 3
Juvenile detention before age 18
Abuse/Neglect Experiences before Age 18:
Someone you lived with:
Left you without adequate food or shelter 12 10 4
Physically abused you, to cause physical harm 22 18 5
Forced you or pressured you to do sexual acts that you did not want to do 13 13 2
Abuse/neglect combinations
Physical and/or sexual abuse but not neglect 25 22 6
One or more abuse/neglect experiences 29 23 8
Out-of-Home Experiences before Age 18:
Place in foster care, group home, or institution 27 19 Not Asked
Ran away from home for more than 24 hours 33 27 Not Asked
Forced to leave home for more than 24 hours 22 19 Not Asked
Homeless for the first time 21 12 Not Asked

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.


More currently than formerly homeless clients (27 and 19 percent, respectively) were placed in foster care, a group home, or other out-of-home placement (figure 3.7). Similar proportions of both groups had been forced to leave home for more than 24 hours (22 and 19 percent, respectively). The two groups differ, however, in the proportion who had run away from home for more than 24 hours (33 percent of currently and 27 percent of formerly homeless clients) and had a homeless experience before the age of 18 (21 and 12 percent). Their answers indicate that many do not consider their runaway experience to be homelessness, since many more in both groups report the former than the latter experience.

Figure 3.7

Income Levels, Sources, and Employment

Currently homeless clients report a lower level of income during the past 30 days, on average, than formerly homeless clients ($367 versus $470, table 3.8).4 Further, 13 percent of currently homeless clients report no cash income at all during the past month, compared with 5 percent of formerly homeless clients. Both are significantly below the federal poverty level of $680 a month for a single person. Median incomes are very low, at $300 for currently homeless and $462 for formerly homeless clients. Other service users report a mean income over the past 30 days of $575, and a median of $514.

Currently homeless clients are more than twice as likely as formerly homeless clients to have incomes below $100 during the past 30 days (30 versus 14 percent). The proportion of clients with incomes below $300 is 49 percent for currently homeless clients, 30 percent for formerly homeless clients, and 21 percent for other service users (figure 3.8).

Currently, compared with formerly, homeless clients are more likely to have worked for pay during the last 30 days (44 versus 34 percent) (table 3.8). However, although they are less likely to work at all, a higher proportion of the work activity of formerly homeless clients is in jobs lasting or expected to last three months or more, whereas more than half of the work done by currently homeless clients is in temporary or day labor jobs. Forty-five percent (20/44 = 45%) of currently homeless clients who work report jobs lasting or expected to last three months or more, compared with 62 percent (21/34 = 62%) of formerly homeless clients with earned income.

Table 3.8
Income Levels, Income Sources, and Employment, by Homeless Status
  Currently Homeless Clients
(N=2938)
Formerly Homeless Clients
(N=677)
Other Service Users
(N=518)
  $367 $470 $575
Median Income from All Sources (Last 30 Days)a 300 462 514
 
Income from All Sources Over Last 30 Days
None 13(%) 5(%) 5(%)
Less than $100 17 9 6
$100 to 299 19 16 10
$300 to 499 18 30 25
$500 to 699 14 20 21
$700 to 799 4 6 7
$800 to 999 5 6 7
$1000 to 1,199 3 2 3
$1200 or more 4 5 12
 
Did Any Paid Work At All in Last 30 Days 44 34 28
 
Sources of Earned Income in Last 30 Days
Job lasting 3 or more months 13 14 16
Job expected to last 3 or more months 7 7 4
Temporary job, non-farm work 8 6 3
Temporary job, farm work 3 * 1
Day job or pick-up job 14 5 5
Peddling or selling personal belongings 2 2 *
 
Received Money/Benefits from Government
Sources in Last 30 Days
Aid to Families with Dependent Children (AFDC) 10 8 10
Aid to Families with Dependent Children (AFDC)-
Only Families with Children 52 45 45
General Assistance 9 16 7
Supplemental Security Income 11 29 26
Social Security Disability Insurance (SSDI) 8 16 10
Social Security 3 6 33
Veteran's disability payments (veterans only) 6 14 23
Veteran's pension (not disability related-veterans only) 2 1 16
Food Stamps 37 48 37
 
Received Means-Tested Government Benefitsb
Any, including food stamps 45 70 56
Any other than food stamps 28 57 47
 
Other Sources of Income Over the Last 30 Days
Parents 9 4 6
Friends (includes boyfriends or girlfriends) 12 9 5
Asking for money on the streets 8 3 *


Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
*Denotes values that are less than 0.5 but greater than 0 percent.
aIf an income range was reported by client, mid-point of range was used in calculating mean.
bAFDC, GA, SSI, food stamps, housing assistance.

Food stamps are the most common source of means-tested government benefits for currently and formerly homeless clients (37 and 48 percent, respectively) (figure 3.9). Currently homeless clients are less likely than formerly homeless clients to receive SSI (11 versus 29 percent). Formerly homeless clients are more likely than currently homeless clients to receive General Assistance (16 versus 9 percent). Formerly homeless clients are also more likely than currently homeless clients to receive SSDI (16 versus 8 percent). Other service users are most likely to get food stamps (37 percent), Social Security (33 percent), and SSI (26 percent).

Figure 3.8

Figure 3.9

History of Homelessness

Currently and formerly homeless clients were asked about their experiences with homelessness, including how many times they had been homeless, the length of their current homeless episode (if homeless now), and the length of the most recent completed episode of homelessness (for formerly homeless clients and currently homeless clients who have been homeless more than once). Results are shown in table 3.9.

Table 3.9
Number and Length of Homeless Periods, by Homeless Status
  Currently Homeless Clients
(N=2938)
Formerly Homelss Clients
(N=677)
Number of Times Homesless for 30 Days or More
1 49(%) 40(%)
2 17 26
3 12 12
4-10 18 15
11 or more 4 6
     
Length of Current Period of Homelessness
< 1 week 5 Not
>= 1 week and < 1 month 8 Applicable
1-3 months 15  
4-6 months 11  
7-12 months 15  
13-24 months 16  
25-60 months 10  
5 or more years 20  
     
Spell History and Current Spell Length
First time homeless    
6 months or less 18 Not
more than 6 months 21 Applicable
Not first time homeless    
4-6 months 15 13
7-12 months 20 21
13-24 months 9 7
25-60 months 5 7
5 or more years 7 8

Source: Urban Institute analysis of weighted 1996 NSHAPC client data.
Note: Numbers do not sum to 100 percent due to rounding.


Currently homeless clients are more likely than those who are formerly homeless to have had only one homeless episode (49 versus 40 percent). Similar proportions of currently and formerly homeless clients (22 and 21 percent) have been homeless four or more times (figure 3.10).

Figure 3.10

Twenty-eight percent of currently homeless clients have been homeless during their present spell for three months or less, while 30 percent have been homeless for two years or more. There are no differences between formerly homeless clients and those among the currently homeless who have had more than one spell regarding the length of their most recent completed spell. The most frequently mentioned spell length was between one and three months (33 and 30 percent, respectively). The next most frequently mentioned category was episodes of 7 to 12 months, indicated by 21 and 20 percent. Relatively few clients reported completing episodes of two years or more (15 and 12 percent).

Use of Homeless Assistance Programs

Clients' use of various homeless assistance programs, including food and other programs in addition to shelters, is reported in table 3.10. Program use within the week before being interviewed for NSHAPC shows significant variation by homeless status. Soup kitchens are the most commonly used program among currently and formerly homeless clients (31 and 35 percent, respectively, report using them at least once during the week before the interview), although the difference between soup kitchen, emergency shelter, and transitional housing program use is not significant for currently homeless clients. Emergency and transitional shelters were each used by about a quarter of currently homeless clients (26 and 28 percent) but, by definition, were not used by formerly homeless clients and other service users. Other service users also report the most use of soup kitchens (19 percent).

Table 3.10
Use of Homeless Assistance Programs, By Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518)
Clients Reporting Program Use In Week Before Interview
Emergency Shelter 28(%) 0(%) 0(%)
Transitional Housing 26 0 0
Sheltera 3 0 0
Permanent Housing 3 11 0
Shelter Vouchers 1 0 0
Soup Kitchen 31 35 19
Food Pantry 5 10 6
Mobile Food Program 5 6 8
Outreach 7 3 1
Drop-in Center 9 10 5
 
Clients Reporting Having Ever Used Program
Emergency Shelter 65 65 0
Transitional Housing 40 23 0
Permanent Housing 10 19 0
Shelter Vouchers 15 18 0
Soup Kitchen 62 74 32
Food Pantry 40 59 50
Mobile Food Program 21 18 17
Outreach 17 14 9
Drop-in Center 26 27 11

Source: Urban Institute analysis of weighed 1996 NSHAPC client data.
aThis included clients who did not report staying in an emergency shelter, transitional shelter, permanent housing, or voucher program over the last seven days but said that they recieved food over the last seven days in the shelter where they live.

Lifetime Service Use

The proportion of clients reporting having ever used various programs or services at some time in their lives is obviously much higher than usage in the week before being interviewed (table 3.10). Equal proportions (65 percent) of currently and formerly homeless clients have used an emergency shelter at some time in their lives. More formerly than currently homeless clients (19 versus 10 percent) have used permanent housing programs (this statistic probably owes a lot to the fact that using the program is part of what gets a person classified as formerly homeless), while the situation is reversed for transitional housing programs (40 versus 23 percent). The two groups report similar access to programs offering vouchers for emergency accommodation (15 and 18 percent).

Formerly compared with currently homeless clients are more likely to have used a soup kitchen in their lifetime (74 versus 62 percent). Formerly homeless clients are more likely than currently homeless clients to have used food pantries (59 versus 40 percent). Mobile food programs have served equal proportions (21 and 18 percent) of currently and formerly homeless clients. Similar proportions of currently and formerly homeless clients have used drop-in centers (26 and 27 percent) and outreach programs (17 and 14 percent). Other service users frequent food pantries (50 percent) and soup kitchens (32 percent), with lower percentages using mobile food programs (17 percent), drop-in centers (11 percent), and outreach programs (9 percent). Use of food programs of all varieties clearly reflects great need related to food among every subgroup of clients included in NSHAPC.

Urban/Rural Location

The urban/rural location of currently and formerly homeless clients and other service users is dramatically different (table 3.11). Currently homeless clients are more likely than formerly homeless clients to be found in central cities (71 versus 64 percent), but the proportion for both is higher than the proportion of the U.S. population in poverty found in these locations. Currently compared with formerly homeless clients are less likely to be found in rural areas (9 versus 19 percent). Other service users are equally likely to be found in central cities and in rural areas (39 and 40 percent).


Table 3.11 Urban/Rural Location, by Homeless Status
  Currently Homeless Clients (N=2938) Formerly Homeless Clients (N=677) Other Service Users (N=518) Poor U. S. Population (1996)
Urban/Rural Location
Central Cities 71(%) 64(%) 39(%) 31(%)
Suburban/Urban Fringe 21 17 21 46
Rural 9 19 40 23

Source: Urban Institute analysis of weighted 1996 NSHAPC client data. Geographic distribution of the poor U.S. population taken from Lamison-White (1997), P60-198, table A.
Note: Numbers do not sum to 100 percent due to rounding.

4 Homeless Assistance Programs


HIGHLIGHTS

Homeless Assistance Programs 1
  • This study estimates that about 40,000 homeless assistance programs operate in the United States, offered at an estimated 21,000 service locations.
  • Food pantries are the most numerous type of program, numbering about 9,000 programs. Emergency shelters are next with about 5,700 programs, followed closely by 4,400 transitional housing programs, 3,500 soup kitchens and other distributors of prepared meals, 3,300 outreach programs, and 3,100 voucher distribution programs.
  • Food pantries expected to have over 1 million program contacts on an average day in February 1996, followed by about 522,000 program contacts expected at soup kitchens. Programs offering financial and/or housing assistance, outreach programs, and emergency shelters all expected to have between 240,000 and 253,000 contacts a day. Expected contacts at health programs were much lower. These estimates of program contacts are probably high for average daily service use, since February is a peak month for many homeless assistance services.
  • Food programs are most likely to be large (37 percent expected more than 100 program contacts daily). Shelter and housing programs are most likely to be small (59 percent expected to serve 25 or fewer clients a day).
  • The biggest programs, though few in number, account for very large proportions of program contacts on an average day. Among food programs, 11 percent report more than 300 program contacts daily, but they account for 55 percent of all contacts with food programs. The pattern is similar for shelter/housing programs. The 8 percent of shelter/housing programs reporting more than 100 program contacts daily provide 51 percent of all contacts in shelter/housing programs.
  • Nonprofit agencies operate 85 percent of all homeless assistance programs. Government agencies operate only 14 percent.
  • Among nonprofits, secular agencies operate 51 percent of homeless assistance programs and religious nonprofits operate 34 percent.
  • Secular nonprofits operate more than half of the housing and other programs, religious nonprofits operate more than half of the food programs, and government operates more than half of the health programs.
  • Food programs are the least dependent on government funding (more than half do not receive any), while health programs are the most dependent on government funding (more than half are funded completely by government). Shelter and housing programs vary more in their reliance on government for funds.
  • Some programs have a special focus on one or more population groups. Victims of domestic violence and veterans are commonly named groups (18 and 14 percent, respectively). Clients who have alcohol, drug, or mental health problems, alone or in combination, are a special focus for 17 to 19 percent of programs, with health programs being particularly likely to name one of these groups.
  • Central cities account for 49 percent of all homeless assistance programs, rural areas for the next largest share at 32 percent, and suburban areas for the fewest at 19 percent. Because central city programs serve more clients, however, a larger share of program contacts happen in central cities (57 percent) than in suburban and rural areas (20 and 23 percent of all program contacts, respectively), which do not differ from each other.
  • Among the 76 primary sampling areas included in NSHAPC, the areas with the most population provide the most homeless assistance services, as expected. However, a different picture emerges when service levels are examined on a per capita basis as a rate per 10,000 population, and also in relation to need as a rate per 10,000 poor people. Using rates makes clear that many medium-sized and even smaller sampling areas actually offer more homeless assistance services in relation to their poor population than larger sampling areas.


Introduction

Over the past decade the number and variety of programs serving homeless clients have grown tremendously, but no national description of this service network has been available. NSHAPC provides the first national description of this service network, covering central cities, suburbs and urban fringe communities, and rural areas. This chapter offers an overview of programs and services available in the United States that have a significant focus on serving homeless clients, spanning a wide variety of program types (exhibit 4.1). Readers interested in a more detailed examination of programs and services are referred to chapters 14 through 17 of Homelessness: Programs and the People They Serve—Technical Report.

Service Locations and Program Types

Estimates from NSHAPC data indicate there are approximately 21,000 service locations in the United States, operating about 40,000 homeless assistance programs. A little over half of the service locations (about 11,000) offer only one homeless assistance program, and a little less than half offer two or more programs. For purposes of this study, a service location is the building or physical space at which one or more programs are offered, and a homeless assistance program is a set of services offered to the same group of clients at a single location (see chapter 1 for a detailed discussion of definitions).


EXHIBIT 4.1 NSHAPC Program Clients
Emergency shelters
Transitional housing
Permanent housing for formerly homeless clients
Voucher distribution for housing
Accept vouchers in exchange for housing
Food pantries
Soup kitchens/meal distribution programs
Mobile food programs
Physical health programs
Mental health programs
Alcohol and/or drug programs
HIV/AIDS programs
Outreach programs
Drop-in centers
Migrant housing used for homeless clients
Other

Three features of NSHAPC's definition of a program are important to keep in mind throughout this chapter: (1) nonhomeless clients often use some of these programs; (2) NSHAPC programs are not the only sources of assistance to homeless clients; and (3) many programs similar to NSHAPC programs may exist in a community but have not been included because they do not target their services toward homeless clients (food pantries and health programs are examples).2

Figure 4.1 shows the estimated number of NSHAPC programs by four general program types of housing, food, health, and other programs. Note that financial/ housing programs (e.g., Emergency Food and Shelter Program, welfare, public housing programs) were not an original NSHAPC category, but were mentioned frequently enough under "other programs" to warrant presentation as a separate category.

Food pantries are the most numerous type of program serving homeless clients, with an estimated 9,000 programs nationwide. Emergency shelters are next, with almost 5,700 programs, followed closely by transitional housing programs (4,400), soup kitchens and other distributors of prepared meals (3,500), outreach programs (3,300), and voucher distribution programs (3,100). As a group, homeless assistance programs with a health focus are least numerous.



Figure 4.1

Source: Weighted NSHAPC data representing programs operating during "an average week in February 1996."
Note: Financial (usually welfare) and housing assistance services were mentioned often enough under "Other" to warrant a category of their own, and migrant housing was combined with "Other" because there were so few programs.



Service Level and Program Size

Of considerable interest to many people are estimates of the number of clients being served by homeless assistance programs. NSHAPC results offer an important overview of service utilization in the United States, but they must be interpreted correctly. Since people may use more than one type of service during an average day, the estimates of service levels made by NSHAPC programs necessarily contain an unknown and unknowable amount of duplication. Their answers cannot be added up to determine the total number of clients who use services on an average day. For that reason they are referred to as "program contacts," not as "clients served." Further, many of the clients using the programs included in NSHAPC are not homeless, so care must be taken to interpret the following figures appropriately, as simple estimates of program use by clients who may need a wide variety of different services and may get them at a variety of programs.

A final caveat is that these figures do not represent all of each type of service available to homeless clients, for two reasons. First, shelters serve meals to their residents, and may also offer some types of health and other services. Therefore, NSHAPC food and health programs do not represent all of the food and/or health services available to homeless clients within a community. Second, some homeless clients get services from mainstream housing, health, and social service programs that were not included in NSHAPC program universe because they do not meet the study's definition of a homeless assistance program.

Figure 4.2

Source:Weighted NSHAPC data representing programs operating during "an average week in February."
Note: These are estimates from NSHAPC program representatives of how many contacts their program expected on an average day in February 1996. They contain duplication and cannot be added together to get the total number of people served on an average day.



Total Number of Expected Service Contacts

For each type of NSHAPC program, figure 4.2 shows how many contacts the programs expected to have on an average day in February 1996. Food pantries as a group clearly expected to have the most program contacts (over 1 million) on an average day, followed by about 520,000 contacts at soup kitchens. Programs offering financial and/or housing assistance, outreach programs, and emergency shelters each expected to have between 240,000 and 250,000 program contacts a day. In contrast, the estimate of program contacts for all four types of health programs with a focus on serving homeless clients, taken together, is only about 140,000, and this estimate is accurate only if each person uses one and only one type of health service on an average day. These figures probably are high estimates for average daily service use, since February is a peak month for many homeless assistance services, and program representatives tend to recall their peak periods rather than their average days.



Figure 4.3

Source: Weighted NSHAPC data representing programs operating during "an average week in February 1996."
Note: These are program staff estimates of how much program contacts their own program expected on an average day in February 1996. They contain duplication and cannot be added together to get the total number of people served on an average day. Housing programs include emergency, transitional, permanent housing, and voucher programs; food programs include pantries, soup kitchens, and mobile food programs; health programs include general health, mental health, alcohol/drug, and HIV/AIDS programs; other programs include outreach, drop-in centers, financial/housing assistance, and other.



Variability in Program Size

Homeless assistance programs vary greatly in size, where size is defined as the number of service contacts expected on an average day in February 1996. Figure 4.3 shows how programs of different types are distributed by size. The figure makes clear that food programs are most likely to be quite large (26 percent expected 101 to 299 service contacts daily and 11 percent expected more than 300 service contacts daily), and only about 1 in 11 expected as few as 1 to 10 service contacts in a day. Shelter and housing programs are likely to be small (28 percent expected 1 to 10 and another 31 percent expected 11 to 25 service contacts a day), with only 2 percent expecting more than 300 service contacts daily. Health and other homeless assistance programs are the most evenly distributed across a range of sizes, with about 40 percent of each expecting 25 or fewer and between 44 and 45 percent of each expecting between 26 and 100 service contacts daily.

The biggest programs, though few in number, account for very large proportions of the clients being served on an average day (figure 4.4). This is true regardless of which type of program one examines, but is most true for shelter/housing programs. The 80 percent of shelter/housing programs serving 50 or fewer clients daily serve only 32 percent of all the clients who use these programs on an average day (in February 1996). On the other hand, the 8 percent of shelter/housing programs serving more than 100 clients daily serve 51 percent of the clients using shelter/housing programs. Indeed, the 2 percent of these programs serving more than 300 clients daily serve 28 percent of all shelter/housing users on an average day.

The story is the same with food and other homeless assistance programs. Only 11 percent of food programs and 5 percent of other programs serve more than 300 clients daily, but these programs accommodate, respectively, 55 percent of everyone getting food from food programs and 55 percent of everyone getting help from other programs on an average day. Service delivery in health programs for homeless clients is less skewed toward the very large programs (over 300 daily) and away from the very small programs (25 or fewer daily), but even here the 42 percent of programs that are very small serve only 7 percent of those who use health programs on an average day, while the very large programs serve 30 percent of health program users.



Figure 4.4

Source: Weighted NSHAPC data representing programs operating during "an average week in February 1996."
Note: These are program staff estimates of how much program contacts their own program expected on an average day in February 1996. They contain duplication and cannot be added together to get the total number of people served on an average day. Housing programs include emergency, transitional, permanent housing, and voucher programs; food programs include pantries, soup kitchens, and mobile food programs; health programs include general health, mental health, alcohol/drug, and HIV/AIDS programs; other programs include outreach, drop-in centers, financial/housing assistance, and other.



Operating Agencies

Nonprofit agencies offer the vast majority (85 percent) of homeless assistance programs (figure 4.5). Secular nonprofits offer 51 percent of all programs, while religious nonprofits offer 34 percent. Government agencies operate 14 percent of all programs, and for-profit firms account for a mere 1 percent.

Figure 4.5

Figure 4.6

Different types of programs are operated by quite different types of agencies (figure 4.6). Secular nonprofit agencies dominate in the housing category, offering 60 percent of all programs, while religious nonprofits dominate in the food category, offering 55 percent of these programs. Health programs are about evenly split between government and nongovernment agencies, with secular nonprofits dominating among the nongovernment agencies that offer health programs for homeless clients.

Government agencies are least likely to operate food programs (5 percent of those programs) and most likely to offer health programs (51 percent of health programs). Secular nonprofits are the most prominent type of agency among other programs offering homeless assistance, which include outreach programs, drop-in centers, housing and financial assistance programs, and other programs. For-profit organizations play almost no role in operating homeless assistance programs (1 percent in housing, health, and other programs, and nothing in food programs).

Funding Sources

Given the different types of agencies operating homeless assistance programs, it should not be surprising that considerable differences also exist across program types in the extent to which they rely on private funding or funding from government sources (federal, state, or local) to support their operations. Figure 4.7 shows these differences as the proportion of program budgets that come from government funding; private funding makes up the balance of each program's budget.

Food programs are the most likely to rely solely on private funding, and to report that they use no government funds (true for 51 percent of food programs). They are also the least likely to be fully supported by government funds (6 percent). Conversely, health programs are the least likely to rely solely on private funding sources (only 12 percent operate entirely without government funding) and the most likely to be fully supported from government sources (55 percent).

In between are housing and other types of homeless assistance programs. One-fourth of all housing programs for homeless clients are fully supported by government funds, and about equal proportions rely entirely on private funds (23 percent) or receive up to half of their budget from government sources (22 percent). The final 30 percent of housing programs receive from half to almost all of their support from government funds. Other homeless assistance programs are split quite evenly among the one-third that rely entirely on private funding, the 34 percent that are completely supported by government, and the one-third whose level of government support falls somewhere in between.

The value of in-kind contributions from private sources are not included in these figures. For many programs, these contributions can be of considerable value and include food, rent-free buildings, equipment, and volunteer time to perform critical program functions.

Population Focus

Some homeless assistance programs are open to anyone who wants to use them, while other programs are designed specifically to serve only certain types of people. Population focus may be defined in several different ways. One common way is by household type, including men by themselves, women by themselves, households with children, and youth by themselves. Other common ways are by the special population groups, such as veterans, youth, victims of domestic violence; or condition or service need, such as alcohol, drug, or mental health problems, or HIV/AIDS, that a program is specifically designed to help. NSHAPC program staff were asked to report each household type that their program serves. In another series of questions, program representatives described any specializations or particular focuses that their program might have. This section reports how programs describe the types of clients they serve on these different dimensions. Since many programs report serving more than one household type, and also report having a focus on more than one special population, condition, or service need, the statistics for each type of program usually sum to more than 100 percent.

Household Type

Figure 4.8 reports the types of households that programs serve. A very noticeable pattern is that food programs are the most inclusive of all household types, with 84 percent or more saying they serve men and women by themselves and both female-headed and other families with children. Housing programs are the most specialized. For instance, 43 percent serve two-parent families with children, 61 percent serve men by themselves, and 68 to 69 percent serve women by themselves and female-headed households with children. Of course, many serve more than one of these household types. These patterns may be due to program policy (i.e., the program will not take particular types of clients) or simply to the fact that few or no clients of a particular type come to the program for service.

Nine out of ten health programs serve men and women by themselves, but only six in ten serve any families with children. Shelter and other housing programs are the least likely to expect unaccompanied youth to use their programs, but all of the other program types also do not expect to serve many of this group.



Figure 4.7

Special Population or Special Need

Respondents were asked whether their program had a particular focus on one or more special populations. These might include a population group, such as victims of domestic violence, runaway youth, and veterans; or special conditions or special needs, such as mental health problems (without alcohol and/or drug use), alcohol and/or drug use (without mental health problems), both alcohol/drug and mental health problems, and HIV/AIDS.

Half of those naming any special focus named only one focus, 17 percent named two focuses, and 33 percent named three or more focuses. The most commonly named special focus was "other" (25 percent). About half (48 percent) of program representatives did not report any special focus; food programs were the most likely and health programs were the least likely to say they had no special focus.

Figure 4.9 identifies special population groups reported as a program's focus, and figure 4.10 does the same for program focus with respect to condition or service need. Overall, figure 4.9 shows that one-third or fewer programs named a special population group as a focus. The group most frequently named by all types of programs is victims of domestic violence, followed by veterans (18 and 14 percent, respectively, of all programs, shown in the first bar in each cluster). There are some important variations by program type, with housing programs being the most likely to name victims of domestic violence as a special population focus (28 percent do so), and health programs being most likely to identify veterans as a special population focus (32 percent do so). No more than 10 percent of programs identify a special focus on youth, regardless of program type.

Figure 4.8

Figure 4.10 shows the proportion of programs responding that they have a focus on serving clients with particular special needs. Overall, people with alcohol, drug, or mental health problems, alone or in combination, are a special focus for 17 to 19 percent of programs. Health programs are by far the most likely to report these focuses. Almost half of health programs say they have a special focus on clients with mental health problems only, and almost half report a special focus on clients with mental health problems plus accompanying alcohol and/or drug use. More than one-third of health programs have a special focus on persons who use alcohol or drugs, and slightly less than one-third of health programs have a special focus on clients with HIV/AIDS.

Figure 4.9

Occupancy Levels of Shelter/Housing Programs

Shelter/housing programs generally report occupancy levels in the 70 percent range (table 4.1). Programs serving homeless families report 73 percent occupancy for most of the year. The slightly higher winter rate of 77 percent for these programs is statistically but probably not substantively significant. Programs serving single homeless men and/or women report occupancy levels of 67 to 69 percent in the spring, summer, and fall, and significantly higher occupancy in the winter (76 percent). The three reasons given most frequently for being less than full are decline in need, seasonal changes, and that the people seeking shelter do not meet program criteria/restrictions. Given that many programs appear in both columns of table 4.1 since they serve both families and single men and/or women, it is not surprising that their reasons for less-than-full occupancy levels are similar.

Location of Homeless Assistance Programs

About half (49 percent) of all homeless assistance programs are found in central cities. Rural communities offer the next largest share of programs (32 percent), and suburban/urban fringe communities offer the smallest share of programs (19 percent) (figure 4.11). However, because central city programs serve more clients, on average, a larger share of program contacts happen in central cities (57 percent) than in suburban and rural areas (20 and 23 percent of all program contacts, respectively).3



Figure 4.10
Source: Weighted NSHAPC data representing programs operating during an "average week in February 1996." Includes all programs, of every type.


Central city, suburban, and rural locations also vary considerably in terms of which programs report the most contacts. Food programs report the most contacts in both central cities and suburban areas (57 and 65 percent of program contacts in those areas, respectively), while in rural areas food program contacts comprise only 31 percent of program contacts (figure 4.12). The share of program contacts that occur in shelter/housing programs are similar for central city and suburban areas (23 and 21 percent, respectively), but are only 11 percent of contacts in rural areas. In contrast, contacts with "other" programs predominate in rural areas (50 percent of contacts), but make up only 16 percent of contacts in central cities and 11 percent of contacts in suburban areas.

Table 4.1
Shelter/Housing Utilization and Information on Turnways
  Programs Serving Families with Children (69 percent of all shelter/housing programs) Programs Serving Single Adults (78 percent of all shelter/housing programs)
Occupancy
Percent occupied in the winter 77(%) 76(%)
Percent occupied in the spring 73 69
Percent occupied in the summer 73 67
Percent occupied in the autumn 73 69
Reasons for Operating at Less Than Full Capacity
Never less than full 26 20
Of remainder, percent citing:a
Decline in need 35 40
Sesonal changes 32 35
Change in program criteria 5 3
New facilities added elsewhere 3 4
Economic/job market changes 11 11
Change in program funding or capacity 10 9
People did not meet program criteria/restricitons 32 34
Other 23 19

Source: Urban Institute analysis of 1996 NSHAPC mail survey data.
aPrograms could give more than one reason.


Availability of Services within NSHAPC's 76 Sampling Areas

So far, this chapter has explored homeless assistance programs and services at the national level and through the broad geographical designations of central cities, suburban areas, and rural areas. NSHAPC also has the capacity to examine variations in programs and program contacts within the survey's 76 primary sampling areas (called "sampling areas" hereafter).4 Program contact information can be segmented to reveal the proportion of services within a sampling area that are shelter/housing program contacts, food program contacts, health program contacts, and other program contacts. Further, program contact information can be used to calculate a rate of program contacts per 10,000 clients in poverty, which is a good measure for comparing the level of service availability across sampling areas of very different sizes (e.g., a city with more than a million people and a rural area of a few thousand people).5



Figure 4.11
Source: Weighted NSHAPC data representing programs operating during "an average week in February 1996." Includes all programs, of every type.


Figure 4.12
Source: Weighted NSHAPC data representing programs operating during "an average week in February 1996." Housing programs include emergency, transitional, permanent housing, and voucher programs; food programs include pantries, soup kitchens, and mobile food programs; health programs include general health, mental health, alcohol/drug, and HIV/AIDS programs; other programs include outreach, drop-in centers, finacial/housing assistance and other.


Distribution of Program Contacts within Sampling Areas

All other things being equal, one might expect the sampling areas with the largest population to provide the most homeless assistance program contacts. To examine this expectation, figure 4.13a arrays each of this study's 76 primary sampling areas from left to right according to the size of its population (largest on the left, smallest on the right).6 Each bar shows the total estimated number of program contacts on an average day in February 1996,7 combining program contacts of all types.

From this figure one can see that the expected relationship of more program contacts in the larger sampling areas is generally true but there are exceptions. The average estimated number of program contacts per sampling area is about 17,600 on an average day in February 1996. But the estimated numbers of program contacts range from a high of about 186,000 to a low of nothing (for two sampling areas that had no programs of any kind) (table 4.2). And variation exists even at the highest end. For example, providers in the largest sampling area estimate only about two-thirds the number of program contacts (about 123,000) as do providers in the next largest sampling area (about 186,000).

Table 4.2
Statistics for Program Contracts on an Average Day in February 1996 in Primary Sampling Areas
  Average High Low Standard Deviation
For Figure 4.13
Aggregate program contracts (4.13a) 17,600 186,000 0 29,600
Program contracts/10,000 population (4.13b 122 660 0 103
Program contracts/10,000 poor people (4.13c) 1,437 9,000 0 1,858
For Figure 4.14
Percentage of all contracts that are shelter/housing contracts (4.14a) 24% 100% 0% 17%
Percentage of all contracts that are food program contracts (4.14b) 49% 90% 0% 23%
Percentage of all contracts that are health program contracts (4.14c) 5% 59% 0% 18%
Percentage of all contracts that are other program contracts (4.14d) 19% 92% 0% 18%
For Figure 4.15
Shelter/housing program contracts /10,000 poor people (4.15a) 195 860 0 153
Emergency shelter program contracts/10,000 poor people (4.15b) 81 405 0 66
Transitional housing program contracts/10,000 poor people (4.15c) 49 238 0 52
Permanent housing program contracts/10,000 poor people (4.15c) 49 238 0 52
Voucher distribution program contracts/10,000 poor people (4.15e) 26 445 0 39

Source: Weighted NSHAPC data representing programs operating during "an average week in February 1996." Housing programs include emergency, transitional, permanent housing, and voucher programs; food programs include pantries, soup kitchens, and mobile food programs; health programs include general health, mental health, alcohol/drug, and HIV/AIDS programs; other programs include outreach, drop-in centers, financial/housing assistance, and other.

To examine how much population size accounts for the differences observed in figure 4.13a, the estimated number of program contacts per 10,000 people is employed. Figure 4.13b shows this rate for each of the 76 sampling areas, arrayed in the same order as figure 4.13a. The average estimated rate of program contacts per 10,000 population in a sampling area is 122. The use of a common denominator (10,000 people) reduces the differences among sampling areas quite a bit. Now one can see that some of the smaller sampling areas in the middle and toward the right of the figure appear to provide more units of homeless assistance services per capita than do some of the largest sampling areas.

Yet another way to look at these data is to ask whether the variability in service levels can be accounted for by the size of a sampling area's population in poverty, and not just by the total number of people in the sampling area. There is some reason to expect that services should be related to poverty, and the number of poor people in a sampling area is the best measure of need that is available for all 76 sampling areas. Some sampling areas could have a lot of people but not very many poor people, while some smaller sampling areas might actually have more poor people than some larger areas. Therefore a second rate was constructed for each sampling area—its rate of program contacts per 10,000 poor people. Figure 4.13c shows the results.

The average estimated rate of program contacts per 10,000 poor people in a sampling area is 1,437. The rate of contacts per 10,000 poor people reduces even further the level of variability in service provision among the largest sampling areas at the left of the graph. The variability in the middle of the graph (medium- and small-sized metropolitan areas) appears to have increased in relation to that in figure 4.13b. The mostly rural areas to the right of figures 4.13b and 4.13c appear to have the greatest variability whichever rate is used.

From the three graphs in figure 4.13 one can draw the conclusion that the biggest sampling areas, which comprise the nation's biggest cities, do not always provide the most services on a per capita basis, even though they obviously provide very large numbers of services. One can also conclude that a great deal of intercommunity variability remains in the provision of homeless services, even after controlling for levels of population and poverty. This level of variability probably stems from important differences in philosophies, policies, resources, and experience among communities.

Distribution of Services within Sampling Areas by Program Type

The next issue to be examined is how the total estimated number of program contacts within each sampling area are distributed among the four major program types of shelter/housing, food, health, and other. The results, shown in figure 4.14, reveal great variation in the proportion of service contacts in sampling areas within shelter/housing, food, health, and other program types.

Figure 4.14a-d shows four panels, one each for shelter/housing, food, health, and other program contacts. The average proportion of program contacts reported by shelter/housing programs is 24 percent, by food programs is 49 percent, by health programs is 5 percent, and by other programs is 19 percent (table 4.2 gives means, highs, lows, and standard deviations). In comparing parts (a) through (d) of figure 4.14, one can see the predominance of food program contacts and the relative paucity of health program contacts. Food program contacts comprise at least 40 percent of all program contacts in most sampling areas (only 17 of the 74 areas with any services have less than 40 percent of their program contacts at food programs, and one-third have more than 60 percent of program contacts at food programs). In contrast, only five sampling areas have as much as 20 percent of program contacts occurring at health programs, and most have less than 10 percent in the health area.

Figure 4.13

The greatest variability occurs in smaller metropolitan areas and rural areas, which are the most likely to have either much more of a concentration in a particular type of service than is true nationally, or much less of a concentration. Some of these sampling areas have all or virtually all of their program contacts in housing programs, others have all or almost all their contacts in "other" programs (such as outreach, drop-in, or housing/financial assistance programs), and a few have a significant share in health programs.

Figure 4.14

Distribution within Sampling Areas of Contacts with Different Types of Shelter/Housing Programs

Shelter/housing program distributions in sampling areas reflect very different decisions about where to invest homeless housing resources. This analysis uses a rate of shelter/housing program contacts per 10,000 poor people. Figure 4.15 provides this information, first for all shelter/housing program types (figure 4.15a), and then separately for each type of shelter and housing program (emergency shelter—figure 4.15b; transitional housing—figure 4.15c; permanent housing for the formerly homeless—figure 4.15d; and vouchers for temporary shelter—figure 4.15e).

Figure 4.15

The estimated national rate of program contacts with all types of shelter and housing programs for homeless people is 195/10,000 poor people. In addition to the two sampling areas with no programs of any kind, one additional sampling area has no shelter/housing program contacts at all.

Emergency shelter contacts per 10,000 poor people in the study's primary sampling areas average 81/10,000. Six sampling areas offer 150 or more shelter/housing contacts per 10,000 poor people, while nine sampling areas offer 20 or fewer emergency shelter contacts per 10,000 poor people including four that do not offer any.

Variability is even greater among primary sampling areas for rates of transitional housing, permanent housing, and voucher distribution. Transitional housing contacts within sampling areas have a national average of 49/10,000 poor people, with eight sampling areas offering more than 100 transitional housing contacts per 10,000 poor people and 23 offering 20 or fewer, including 13 that offer none.

Permanent housing contacts within sampling areas have a national average of 40/10,000 poor people, with seven sampling areas offering more than 100 permanent housing contacts per 10,000 poor people and 42 offering 20 or fewer, including 20 that offer none.

Voucher distribution contacts within sampling areas have a national average of 26/10,000 poor people, with four sampling areas offering more than 100 voucher program contacts per 10,000 poor people and 50 offering 20 or fewer, including nine that offer none.


5 Postscript

NSHAPC offers the first opportunity since 1987 to examine homeless assistance programs and their clients across the nation. This landmark survey provides nationally representative data about the providers of homeless assistance and the characteristics of currently homeless and other persons who use services, information that is vital to national discussions about homelessness.

The study reveals that the level and type of homeless assistance programs across America are as diverse as homeless people themselves. The homeless people these programs serve have very limited income and other resources, and a complex array of needs. And homeless people are present in rural areas as well as urban and suburban locations.

The study also allows valuable comparisons between 1987 and 1996 of the characteristics of homeless people using shelters and soup kitchens in central cities. It shows that the already high percentages of racial and ethnic minorities using these services in 1987 became even higher by 1996. Although educational levels, income, and receipt of a variety of means-tested government benefits were higher in 1996 than in 1987, extreme poverty remained a central fact of life for homeless clients, whose income was generally half or less of the federal poverty level.

Since 1996, there have been major changes to the national, state, and local social welfare systems that are reportedly having significant impacts on America's low-income people. The impacts on homeless persons, both positive and negative, need to be identified. Comparing the findings of the 1987 and 1996 studies would provide important guidance for needed changes to homeless programs and mainstream social welfare programs.

In a similar manner, communities around the nation will need to conduct their own studies to guide local homeless and mainstream policy decisions. The methodology used in this study provides procedures and questionnaires that are readily adaptable for local surveys. Such surveys would offer local policymakers the twin advantages of having their own data and being able to see how local programs and service users compare to those in the nation as a whole.

Finally, future studies might consider specific objectives—such as the effectiveness of homeless assistance programs or estimates of the number of homeless people—that this survey was not designed to address.


APPENDIX
A.1
NSHAPC's Primary Sampling Areas

Appendix A.1: NSHAPC's Primary Sampling Areas Arrayed Alphabetically within Types

28 Largest Metropolitan Areas 24 Smaller Metropolitan Areas
  • Atlanta, GA
  • Baltimore, MD
  • Boston, MA-NH
  • Chicago, IL
  • Cleveland-Lorain-Elyria, OH
  • Dallas, TX
  • Denver, CO
  • Detroit, MI
  • Houston, TX
  • Kansas City, MO-KS
  • Los Angeles-Long Beach, CA
  • Miami, FL
  • Minneapolis-St. Paul, MN-WI
  • Nassau-Suffolk, NY
  • New York, NY
  • Newark, NJ
  • Oakland, CA
  • Orange County, CA
  • Philadelphia, PA-NJ
  • Phoenix-Mesa, AZ
  • Pittsburgh, PA
  • Riverside-San Bernardino, CA
  • St. Louis, MO-IL
  • San Diego, CA
  • San Francisco, CA
  • Seattle-Bellevue-Everett, WA
  • Tampa-St. Petersburg-Clearwater, FL
  • Washington, DC-MD-VA-WV
  • Bangor, ME
  • Bergen-Passaic, NJ
  • Birmingham, AL
  • Boise City, ID
  • Bremerton, WA
  • Dover, DE
  • Enid, OK
  • Indianapolis, IN
  • Jackson, MI
  • Kenosha, WI
  • Las Cruces, NM
  • Lincoln, NE
  • Melbourne-Titusville-Palm Bay, FL
  • Norfolk-Virginia Beach-Newport News, VA-NC
  • Oklahoma City, OK
  • Redding, CA
  • Sacramento, CA
  • Salt Lake City-Ogden, UT
  • Savannah, GA
  • Shreveport-Bossier City, LA
  • Springfield, MA
  • Utica-Rome, NY
  • York, PA
  • Youngstown-Warren, OH
24 Rural Areas
  • Lassen County, Modoc County, CA
  • Chester town, Deep River town, Essex town, Lyme town, Westbrook town, CT
  • Bradford County, Columbia County, Dixie County, Hamilton County, Lafayette County, Madison County, Suwannee County, Taylor County, Union County, FL
  • Crisp County, Dooly County, Macon County, Marion County, Schley County, Sumter County, Taylor County, Webster County, GA
  • Christian County, Clay County, Effingham County, Fayette County, Montgomery County, Moultrie County, Shelby County, IL
  • Buena Vista County, Clay County, Dickinson County, Emmet County, O'Brien County, Osceola County, Palo Alto County, Pocahontas County, IA
  • Bath County, Menifee County, Montgomery County, Morgan County, Rowan County, KY
  • Union Parish, LA
  • Caldwell County, Daviess County, Grundy County, Harrison County, Linn County, Livingston County, Mercer County, Putnam County, Sullivan County, MO
  • Hall County, Hamilton County, Merrick County, NE
  • Esmeralda County, Mineral County, NV
  • Chaves County, Lea County, NM
  • Cibola County, McKinley County, NM
  • Iredell County, NC
  • Hancock County, Hardin County, Putnam County, Wyandot County, OH
  • Haskell County, Latimer County, Le Flore County, Pittsburg County, OK
  • Douglas County, OR
  • Bedford County, Fulton County, Huntingdon County, Juniata County, Mifflin County, PA
  • Abbeville County, Greenwood County, Laurens County, McCormick County, Newberry County, Saluda County, SC
  • Houston County, Humphreys County, Stewart County, TN
  • Aransas County, Bee County, Live Oak County, Refugio County, TX
  • Accomack County, Northampton County, VA
  • Burnett County, Clark County, Rusk County, Sawyer County, Taylor County, Washburn County, WI Johnson County, Sheridan County, WY


APPENDIX
A.2
Primary Sampling Areas Sorted by Population Size, in Descending Order

  • Los Angeles—Long Beach, CA
  • New York, NY
  • Chicago, IL
  • Philadelphia, PA-NJ
  • Boston, MA-NH
  • Detroit, MI
  • Washington, DC-MD-VA-WV
  • Houston, TX
  • Atlanta, GA
  • Dallas, TX
  • Nassau-Suffolk, NY
  • Riverside-San Bernardino, CA
  • Minneapolis-St. Paul, MN-WI
  • San Diego, CA
  • St. Louis, MO-IL
  • Orange County, CA
  • Pittsburgh, PA
  • Baltimore, MD
  • Phoenix-Mesa, AZ
  • Cleveland-Lorain-Elyria, OH
  • Oakland, CA
  • Tampa-St. Petersburg-Clearwater, FL
  • Seattle-Bellevue-Everett, WA
  • Miami, FL
  • Newark, NJ
  • Denver, CO
  • San Francisco, CA
  • Kansas City, MO-KS
  • Norfolk-Virginia Beach-Newport News, VA-NC
  • Indianapolis, IN
  • Sacramento, CA
  • Bergen-Passaic, NJ
  • Salt Lake City-Ogden, UT
  • Oklahoma City, OK
  • Birmingham, AL
  • Springfield, MA
  • Youngstown-Warren, OH
  • Melbourne-Titusville-Palm Bay, FL
  • Shreveport-Bossier City, LA
  • York, PA
  • Utica-Rome, NY
  • Boise City, ID
  • Savannah, GA
  • Lincoln, NE
  • Abbeville County, Greenwood County, Laurens County, McCormick County, Newberry County, Saluda County, SC
  • Bremerton, WA
  • Bedford County, Fulton County, Huntingdon County, Juniata County, Mifflin County, PA
  • Christian County, Clay County, Effingham County, Fayette County, Montgomery County, Moultrie County, Shelby County, IL
  • Bradford County, Columbia County, Dixie County, Hamilton County, Lafayette County, Madison County, Suwannee County, Taylor County, Union County, FL
  • Hancock County, Hardin County, Putnam County, Wyandot County, OH
  • Jackson, MI
  • Redding, CA
  • Bangor, ME
  • Las Cruces, NM
  • Kenosha, WI
  • Chaves County, Lea County, NM
  • Dover, DE
  • Buena Vista County, Clay County, Dickinson County, Emmet County, O'Brien County, Osceola County, Palo Alto County, Pocahontas County, IA
  • Burnett County, Clark County, Rusk County, Sawyer County, Taylor County, Washburn County, WI Haskell County, Latimer County, Le Flore County, Pittsburg County, OK
  • Douglas County, OR
  • Iredell County, NC
  • Crisp County, Dooly County, Macon County, Marion County, Schley County, Sumter County, Taylor County, Webster County, GA
  • Cibola County, McKinley County, NM
  • Caldwell County, Daviess County, Grundy County, Harrison County, Linn County, Livingston County, Mercer County, Putnam County, Sullivan County, MO
  • Bath County, Menifee County, Montgomery County, Morgan County, Rowan County, KY
  • Hall County, Hamilton County, Merick County, NE
  • Aransas County, Bee County, Live Oak County, Refugio County, TX
  • Enid, OK
  • Accomack County, Northampton County, VA
  • Lassen County, Modoc County, CA
  • Houston County, Humphreys County, Stewart County, TN
  • Johnson County, Sheridan County, WY
  • Chester town, Deep River town, Essex town, Lyme town, Westbrook town, CT
  • Union Parish, LA
  • Esmeralda County, Mineral County, NV



APPENDIX
B
NSHAPC Program Definitions

A program was defined for NSHAPC as a set of services offered to the same group of clients at a single location. To be considered a program, a provider had to offer services or assistance that were (1) managed or administered by the agency (i.e., the agency provides the staff and funding); (2) designed to accomplish a particular mission or goal; (3) offered on an ongoing basis; (4) focused on homeless clients as an intended population (although not always the only population); and (5) not limited to referrals or administrative functions.

This definition of "program" was used in metropolitan areas. However, because rural areas often lack homeless-specific services, the definition was expanded in rural areas to include agencies serving some homeless clients even if this was not a focus of the agency. About one-fourth of the rural programs in NSHAPC were included as a result of this expanded definition.

NSHAPC covered 16 types of homeless assistance programs, defined as follows: Emergency shelter programs provide short-term housing on a first-come, first-served basis where clients must leave in the morning and have no guaranteed bed for the next night OR provide beds for a specified period of time, regardless of whether or not clients leave the building. Facilities that provide temporary shelter during extremely cold weather (such as churches) and emergency shelters or host homes for victims of domestic violence and runaway or neglected children and youth were also included.

Transitional housing programs have a maximum stay for clients of two years and offer support services to promote self-sufficiency and to help them obtain permanent housing. They may target any homeless subpopulation, such as persons with mental illnesses, persons with AIDS, runaway youths, victims of domestic violence, homeless veterans, etc.

Permanent housing programs for formerly homeless clients provide long-term housing assistance with support services for which homelessness is a primary requirement for program eligibility. Examples include the Shelter Plus Care Program, the Section 8 Moderate Rehabilitation Program for Single-Room Occupancy (SRO) Dwellings, and the Permanent Housing for the Handicapped Homeless Program administered by the Department of Housing and Urban Development (HUD). These programs also include specific set-asides of assisted housing units or housing vouchers for homeless clients by public housing agencies or others as a matter of policy, or in connection with a specific program (e.g., the HUD-VA Supported Housing Program, "HUD-VASH"). A permanent housing program for formerly homeless clients does NOT include public housing, Section 8, or federal, state, or local housing assistance programs for low-income persons that do not include a specific set-aside for homeless clients, or for which homelessness is not a basic eligibility requirement.

Voucher distribution programs provide homeless persons with a voucher, certificate, or coupon that can be redeemed to pay for a specific amount of time in a hotel, motel, or other similar facility.

Programs accepting vouchers provide homeless persons with temporary accommodation in a hotel, motel, board and care home, or other similar facility in exchange for a voucher, certificate, or coupon.

Food pantry programs are programs that distribute uncooked food in boxes or bags directly to low-income clients, including homeless clients.

Soup kitchen programs include soup kitchens, food lines, and programs distributing prepared breakfasts, lunches, or dinners. These programs may be organized as food service lines, bag or box lunches, or tables where clients are seated, then served by program personnel. These programs may or may not have a place for individuals to sit and eat meals.

Mobile food programs are programs that visit designated street locations for the primary purpose of providing food to homeless clients.

Physical health care programs provide health care to homeless clients, including health screenings, immunizations, treatment for acute health problems, and other services that address physical health issues. Services are often provided in shelters, soup kitchens, or other locations frequented by homeless clients.

Mental health care programs provide services for homeless clients to improve their mental or psychological health or their ability to function well on a day-to-day basis. Specific services may include case management, assertive community treatment, intervention or hospitalization during a moment of crisis, counseling, psychotherapy, psychiatric services, and psychiatric medication monitoring.

Alcohol/drug programs provide services to assist homeless clients to reduce their levels of alcohol or other drug addiction, or to prevent substance abuse among homeless clients. Programs may include detoxification services, sobering facilities, rehabilitation programs, counseling, treatment, and prevention and education services.

HIV/AIDS programs provide services for homeless clients that specifically respond to the fact that clients have HIV/AIDS, or are at risk of getting HIV/AIDS. Services may include health assessment, client day care, nutritional services, medications, intensive medical care when required, health, mental health, and substance abuse services, referral to other benefits and services, and HIV/AIDS prevention and education services.

Drop-in center programs provide daytime services primarily for homeless clients, such as television, laundry facilities, showers, support groups, and service referrals, but do not provide overnight accommodations.

Outreach programs contact homeless clients to offer food, blankets, or other necessities in such settings as on the streets, in subways, under bridges, and in parks to assess needs and attempt to engage them in services; to offer medical, mental health, and/or substance abuse services; and/or to offer other assistance on a regular basis (at least once a week) for the purpose of improving their health, mental health, or social functioning, or increasing their use of human services and resources. Services may be provided during the day or at night.

Migrant housing is housing that is seasonally occupied by migrating farm workers. During off-season periods it may be vacant and available for use by homeless persons.

Other programs are programs described and offered by providers that met the basic NSHAPC definition of a homeless assistance program. Types of programs actually identified through the survey include housing/ financial assistance (e.g., from Community Action, county welfare, or housing agencies); Emergency Food and Shelter Program agencies; job training for the homeless; clothing distribution; and other programs.




References

Anderson, L.M., M.I. Janger, and K.L.M. Pandon. 1995. An Evaluation of State and Local Efforts to Serve the Educational Needs of Homeless Children and Youth. Washington, DC: Policy Studies Associates.

Bassuk, E.L., J.C. Buckner, L.F. Weinreb, A. Browne, S.S. Bassuk, R. Dawson, and J.N. Perloff. 1997. "Homelessness in Female-Headed Families: Childhood and Adult Risk and Protective Factors." American Journal of Public Health 87(2): 241-48.

Burt, M.R., and B.E. Cohen. 1989. America's Homeless: Numbers, Characteristics, and the Programs that Serve Them. Washington, DC: Urban Institute Press.

Bureau of the Census. 1997a. Statistical Abstract of the United States: 1997. Washington, DC: U.S. Department of Commerce.

Bureau of the Census. 1997b. School Enrollment&#nbsp;Social and Economic Characteristics of Students: October 1995 (Update). Detailed tables and documentation for P20-492. Washington, DC: U.S. Department of Commerce.

Bureau of the Census. 1992. Poverty in the United States: 1991. Series P60-181. Washington, DC: U.S. Department of Commerce.

Caton, C.L.M., P.E. Shrout, P.F. Eagle, L.A. Opler, A. Felix, and B. Dominguez. 1994. "Risk Factors for Homelessness among Schizophrenic Men: A Case- Control Study." American Journal of Public Health 84: 265-70.

Dennis, M.L., and K.A. McGeary. 1998. "Adolescent Alcohol and Marijuana Treatment: Kids Need It Now." SCAT's TIE Communique Newsletter. Rockville, MD: SAMSHA.

Department of Veterans Affairs. 1995. Personal communication.

Food and Consumer Service. 1999. Data from the 1995 Current Population Survey Food Security Supplement, supplied for this report. Washington, DC: U.S. Department of Agriculture.

Fureman, B., G. Parikh, A. Bragg, and A.T. McLellan. 1990. Addiction Severity Index: Fifth Edition. Philadelphia, PA: University of Pennsylvania/Veterans Administration Center for Studies of Addiction.

Herman, D.B., E.S. Susser, E.L. Struening, and B.L. Link. 1997. "Adverse Childhood Experiences: Are They Risk Factors for Adult Homelessness?" American Journal of Public Health 87(2): 249-55.

Interagency Council on the Homeless. 1994. Priority: Home! The Federal Plan to Break the Cycle of Homelessness. Washington, DC: U.S. Department of Housing and Urban Development.

Koegel, P., and M.A. Burnam. 1991. "The Course of Homelessness Study: Aims and Designs." Paper presented at the 119th Annual Meeting of the American Public Health Association, November 1991, Atlanta, GA. Santa Monica, CA: RAND Corporation.

Koegel, P., M.A. Burnam, and S.C. Morton. 1996. "Enumerating Homeless People: Alternative Strategies and Their Consequences." Evaluation Review 20: 378- 403.

Koegel, P., E. Melamid, and M.A. Burnam. 1995. Childhood Risk Factors for Homelessness among Homeless Adults. American Journal of Public Health 85(12): 1642-9.

Lamison-White, L. 1997. Poverty in the United States: 1996. Series P60-198. Washington, DC: U.S. Department of Commerce, Bureau of the Census.

Link, B., J. Phelan, M. Bresnahan, A. Stueve, R. Moore, and E. Susser. 1995. "Lifetime and Five-Year Prevalence of Homelessness in the United States: New Evidence on an Old Debate." American Journal of Orthopsychiatry 65(3): 347-54.

Link, B., E. Susser, A. Stueve, J. Phelan, R. Moore, and E. Struening. 1994. "Lifetime and Five-Year Prevalence of Homelessness in the United States." American Journal of Public Health 84: 1907-12.

Mangine, S.J., D. Royse, and V.R. Wiehe. 1990. "Homelessness among Adults Raised as Foster Children: A Survey of Drop-In Center Users. Psychological Reports 67: 739-45.

Piliavin, I., M. Sosin, and A.H. Westerfelt. 1993. "The Duration of Homeless Careers: An Exploratory Study." Social Service Review 67: 576-98.

Robertson, M.J., C. Zlotnick, and A.H. Westerfelt. 1997. "Drug Use Disorders and Treatment Contact among Homeless Adults in Alameda County, California." American Journal of Public Health 87(2): 217-20.

Rosenheck, R.A., C. Leda, L.K. Frisman, J. Lam, and A. Chung. 1996. "Homeless Veterans." Homelessness in America (Jim Baumohl, ed.). Phoenix, AZ: Oryx Press.

Second Harvest. 1997. Hunger 1997: The Faces and Facts. Chicago: Author.

Susser, E.S., E.L. Struening, and S.A. Conover. 1987. "Childhood Experiences of Homeless Men." American Journal of Psychiatry 144: 1599-1601.

Susser, E.S., S.P. Lin, S.A. Conover, and E.L. Struening. 1991. "Childhood Antecedents of Homelessness in Psychiatric Patients." American Journal of Psychiatry 148: 1026-30.

U.S. Department of Housing and Urban Development. 1989. A Report on the 1988 National Survey of Shelters for the Homeless. Washington, DC: Office of Policy Development and Research.

Weitzman, B.C., J.R. Knickman, and M.B. Shinn. 1992. "Predictors of Shelter Use among Low-Income Families: Psychiatric History, Substance Abuse, and Victimization. American Journal of Public Health 82: 1547-50.

Wood, D., R.B. Valdez, T. Hayaski, and A. Shen. 1990. "Homeless and Housed Families in Los Angeles: A Study Comparing Demographic, Economic, and Family Function Characteristics. American Journal of Public Health 80: 1049-52.

Zanis, D.A., A.T. McLellan, R.A. Cnaan, and M. Randall. 1994. "Reliability and Validity of the Addiction Severity Index with a Homeless Sample." Journal of Substance Abuse Treatment 2(6): 541-48.



Notes

Preface Notes

1. The 12 federal agency sponsors include the Departments of Housing and Urban Development, Health and Human Services, Veterans Affairs, Agriculture, Commerce, Education, Energy, Justice, Labor, and Transportation as well as the Social Security Administration and the Federal Emergency Management Agency.

2. Two other items related to the survey are currently available. Lists containing the names, addresses, and telephone numbers of the homeless assistance providers in each of the 76 survey areas are available from the Interagency Council on the Homeless, HUD, 451 7th Street, S.W., Washington, DC 20410, Room 7274, or by emailing survey_results@hud.govsurvey_results@hud.gov. Public use data files on CD may be purchased from Census Bureau Customer Service; call (301) 457-4100. Files are also available for downloading: go to www.census.gov and then click on "H" under the alphabetical listing "A-Z."

Chapter 1 Notes

*Programs included emergency shelters, transitional and permanent housing programs, voucher distribution programs, food pantries, soup kitchens, mobile food programs, outreach programs, drop-in centers, and other programs.

1. The 12 federal sponsoring agencies are the U.S. Departments of Housing and Urban Development, Health and Human Services, Veterans Affairs, Agriculture, Commerce, Education, Energy, Justice, Labor, and Transportation; the Social Security Administration; and the Federal Emergency Management Agency.

2. Readers interested in more detail about the methods used in NSHAPC should read chapters 1 and 2 in Homelessness: Programs and the People They Serve—Technical Report, and that report's appendixes dealing with sampling, weighting, and the survey instruments.

3. Appendix A provides the full list of the 76 primary sampling areas.

4. Appendix B provides full program definitions.

5. The Addiction Severity Index is an instrument developed by the National Institute on Drug Abuse (Fureman, Parikh, Bragg, and McLellan 1990). It contains subscales to measure a respondent's level of problems with alcohol, with drugs, and with mental or emotional problems. Cutoff levels used in this report are slight modifications of the means reported in Zanis, McLellan, Cnaan, and Randall (1994).

6. This item is part of question 10.1 of the client survey, that asked about current medical conditions.

7. See Homelessness: Programs and the People They Serve—Technical Report, chapter 8 and/or question 13.14 of the client survey (appendix E of the Technical Report) for a list of these drugs.

8. See Homelessness: Programs and the People They Serve—Technical Report, chapter 8 and/or question 12.1 of the client survey (appendix E of the Technical Report) for a list of these emotional and psychological conditions.

Chapter 2 Notes

1. Unless noted specifically, all comparisons are significant at p less than or equal to .10 and all percentages presented by themselves have a 90 percent confidence interval no larger than ±4 percentage points. Confidence intervals greater than ± percentage points will be noted with a footnote as: 90% C.I. = X percentage points.

2. Data were collected in late 1996, when Temporary Assistance for Needy Families (TANF) had not yet taken effect and AFDC was still the relevant cash benefit program.

3. Bassuk et al. 1997; Caton et al. 1994; Herman et al. 1997; Interagency Council on the Homeless 1994; Koegel and Burnam 1991; Koegel, Burnam, and Morton 1996; Koegel, Melamid, and Burnam 1995; Mangine, Royse, and Wiehe 1990; Piliavin, Sosin, and Westerfelt 1993; Robertson, Zlotnick, and Westerfelt 1997; Susser, Struening, and Conover 1987; Susser et al. 1991; Weitzman, Knickman, and Shinn 1992; Wood et al. 1990.

4. For simplicity, the term "homeless" is used throughout this report to mean currently homeless.

5. Sex distribution of U.S. adult population calculated from Bureau of the Census (1997a), table 14.

6. Age distribution of U.S. adult population calculated from the Bureau of the Census (1997a), table 14.

7. Age distribution of U.S. adult population in 1996 calculated from the Bureau of the Census (1997a), table 14.

8. Marital status of U.S. adult population in 1996 obtained from the Bureau of the Census (1997a), table 58.

9. Educational attainment in 1990 of U.S. adult population (25 and older) obtained from the Bureau of the Census (1997a), table 245.

10. The 90 percent confidence interval for the percent of women who have children under 18 is ±6 percentage points.

11. Age distribution in 1996 of all children obtained from the Bureau of the Census (1997a), table 16.

12. This level of regular school attendance may seem high in light of a study done for the U.S. Department of Education that found in a series of field visits that about one-fourth of school-age homeless children experience some interruptions in schooling (Anderson, Janger, and Panton 1995). Both sources of information are likely to have their biases (parental self-report for NSHAPC clients, including personal definitions of what constitutes "regular" school attendance, and small and possibly unrepresentative field sites for the Anderson et al. study). In addition, it is possible that homeless children have trouble attending school when they first become homeless, but that these difficulties have been overcome for many in a sample that includes families with relatively long homeless spells.

13. Bureau of the Census (1997b), table 1.

14. Statistics for the whole U.S. population and all poor persons in the United States were calculated from the Bureau of the Census (1997a), table 22, and (1997b), table 1.

15. Information in this and the following paragraphs about food problems for all and poor U.S. households comes from the Current Population Survey Food Security Supplement, April 1995 (Food and Consumer Service, 1999).

16. 90% C.I. = 12 percentage points.

17. People who report regular use of marijuana (three or more times a week) but do not report any other drug use are included in estimates of people reporting problems with drug use. Were they to be excluded, the proportion with any drug problem would drop for the past month by about 6 percentage points, for the past year by about 8 percentage points, and for lifetime by about 10 percentage points. However, the proportion with any ADM would drop only by about 2 percentage points each for past month, past year, and lifetime ADM problem.

18. Most of this 6 percent reporting temporary housing with no overlap to shelters or streets actually indicated in other ways that they are currently homeless, including having been found in an emergency or transitional shelter; saying they got food at the shelter where they lived; or saying in answer to the basic screener question that the last time they had a permanent place to live was more than seven days ago.

19. Clients were not asked about their use of health, mental health, alcohol/drug, or HIV/AIDS programs.

20. The standard deviation for the $367 average past month income for all homeless clients was $354; for families the standard deviation on their average income of $475 was $342; for singles the standard deviation on their average income of $348 was $353.

21. The exception to this generalization is people who became homeless in a large central city. There is no category to represent any moves of these people to larger places, although the 66 percent of this group who moved to another large central city may well have been moving to a larger place.

22. The mean spell length in both studies is so much higher than the median spell length because about one-fifth of each sample have spell lengths in excess of 60 months, and very long spells affect the mean much more than they do the median.

23. Adjusted for inflation to 1996 dollars using CPI-U.

Chapter 3 Notes

1. Unless noted specifically in the text, all comparisons are significant at p = .10 or better, and all percentages presented by themselves have a 90 percent confidence interval no larger than 4 percentage points. Confidence intervals greater than 4 percentage points will be noted in the text as: 90% C.I. = X percentage points.

2. Obtaining a representative sample of all formerly and never homeless individuals in the United States would require a completely different data collection strategy. Specifically, one would need to take a random sample of the housed population of the United States such as those conducted by Link and his colleagues (Link et al. 1994, 1995).

3. Current Population Survey Food Security Supplement, April 1995, table 1 (Food and Consumer Service 1999).

4. The standard deviation for the $367 average past month income for currently homeless clients was $354; for formerly homeless clients the standard deviation on their average income of $470 was $317; for other service users the standard deviation on their average income of $575 was $380.

Chapter 4 Notes

1. Unless noted specifically in the text, all comparisons are significant at p = .10 or better, and all percentages presented by themselves have a 90 percent confidence interval no larger than ±4.0 percentage points. Confidence intervals greater than 4 percentage points will be noted in the text as: 90% C.I. = X percentage points.

2. For example, the 9,000+ food pantries estimated from the NSHAPC sample (which include food pantries in metropolitan as well as rural areas) are only 27 percent of the 34,000+ food pantries, and NSHAPC's estimate of approximately 3,500 soup kitchens is only 45 percent of the 7,700+ soup kitchens identified by Second Harvest in its 1997 survey (Second Harvest 1997).

3. "Program contacts" are the sum of all program estimates of people they expected to serve on an average day in February 1996. The phrase "program contacts" is used to remind the reader that these estimates contain an unknown and unknowable amount of duplication, as people could and many do use more than one program in a day. Note also that these figures differ from the geographic distribution of homeless clients because they reflect all clients, homeless or not.

4. Appendix A provides two lists of these areas: list A.1, ordered alphabetically within type (28 largest MSAs, 24 small- and medium-sized MSAs, 24 groups of rural counties), and list A.2, ordered by the size of the sampling areas' total population in 1996. The order of sampling areas in figures 4.13, 4.14, and 4.15 follows the A.2 order.

5. In two rural sampling areas, CATI interviews could not discover any homeless assistance programs at all. Results for these two areas are shown in the following figures as zeros.

6. The 28 largest MSAs are the 28 leftmost bars. However, five rural areas have more population than five of the medium- and small-sized MSAs, so the remaining bars do not divide cleanly into the 24 medium- and small-sized MSAs and the rural sampling areas.

7. The reader is not expected to follow each sampling area through each of the panels in figures 4.13, 4.14, and 4.15. Rather, these figures provide an overall visual impression of the large variation across sampling areas in the level of program contacts of all types (figure 4.13), the share of all programs falling within a given program type (figure 4.14), and the share of housing/shelter programs falling within emergency, transitional, permanent, and voucher programs. For detailed information on each sampling area, see Homelessness: Programs and the People They Serve—Technical Report, chapter 17 and its appendix tables.



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