The Data Dilemma in Family Homelessness

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COMMENTARY

The Data Dilemma in Family Homelessness Barbara L. Brush, PhD Laura E. Gultekin, PhD Elizabeth C. Grim, MSW, MPH Abstract: Current estimates of homelessness in the U.S. are biased toward counts of sheltered or visibly unsheltered individuals. Those who remain out of sight during counts and/or live in places or circumstances that elude the United States Department of Housing and Urban Development’s (HUD) definition of homelessness remain undercounted. Underreporting the unique characteristics associated with subgroups of people experiencing homelessness also limits access to the services that best meet their needs. As national counts drive policy and funding for housing-related services, front-line providers have too few resources to treat less visible and understood populations. We argue that homeless families are particularly vulnerable to these trends and explore how current data collection and reporting approaches thwart family homelessness interventions and prevention. Key words: Family homelessness, point-in-time counts, homeless management information systems, homeless populations.

I

n the wake of a 3% decline in the number of families experiencing homelessness across the United States (U.S.), one might conclude that efforts to reduce family homelessness have been successful or that families face less risk for housing instability than other groups.1 Those of us working with homeless families know all too well, however, that national estimates are misleading, primarily because of how we count homeless people. Indeed, the problem of accurately measuring homelessness has been persistently noted since the early 1980s, when homelessness surged across the nation in the wake of mental health deinstitutionalization, economic recession, a shortage of affordable housing, unemployment, and reductions in social spending.2–4 Early estimates of millions of homeless people were made in the absence of active reporting and counting mechanisms.5 Still, in 1983, the 98th Congress, in response to reports of a growing tide of poor and unhoused people, included provisions for food distribution and emergency shelter as part of Public Law 98-8 and appropriated $50 million to the Federal Emergency Management Agency (FEMA) for local communities in need.6 Additional appropriaDR. BRUSH is the Carol J. and F. Edward Lake Professor of Population Health in the University of Michigan School of Nursing in Ann Arbor, Michigan. DR. GULTEKIN is an Assistant Professor in the University of Michigan School of Nursing in Ann Arbor, Michigan. MS. GRIM is an Evaluation Consultant at The Consultation Center, Yale School of Medicine in New Haven, Connecticut. Please send correspondence to Dr. Barbara L. Brush at the University of Michigan, School of Nursing, 426 N. Ingalls, Ann Arbor, Michigan, 48109‑5482. © Meharry Medical College Journal of Health Care for the Poor and Underserved 27 (2016): 1046–1052.

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tions were made to increase addiction and mental health services and to support the Feeding Program for Women, Infants, and Children (WIC).4 Public Law 98-18, enacted six months later, allocated another $60 million to the U.S. Department of Housing and Urban Development (HUD) to support programs and shelters for the homeless. The U.S. Department of Housing and Urban Development published its first national profile of homelessness in 1984, highlighting the magnitude of the problem across the U.S., the composition of America’s homeless, and the extent to which shelters and programs were meeting their needs.7 Sources of HUD data included interviews with 500 “knowledgeable local observers”[p.5] from 60 randomly selected metropolitan communities, a national survey of emergency shelter operators, site visits to 10 of the 60 metropolitan areas, discussions with public health leaders, and reviews of local studies and reports on homelessness. Estimates of the number of people experiencing homelessness were calculated from phone interviews with local representatives who were asked for their “best guess” of how many homeless people were residing in their community at the point of time of their interview (either December 1983 or January 1984).7 Estimates ranged broadly from as few as eight or nine people in Bowling Green, Kentucky to over 33,000 in Los Angeles, California.7 Applying weighted calculations based on reported guesses and geographic location, HUD estimated that 254,000 people were homeless in 1983.7 Today, HUD determines the extent of homelessness through two primary sources: 1) the Point-in-Time count (PIT), which occurs on one night in January to provide a snapshot of the number of sheltered and unsheltered homeless across the nation, and 2)  an annual report from the Homeless Management Information System (HMIS), which includes demographic and service utilization information about people connected with local HUD-supported housing or homelessness services.8 The 2014 PIT counted 216,261 people in 67,613 families (defined as a household of at least one adult and one child) across the U.S.; most were single female-headed households with two young children (79%), located in urban areas (84%), and living in shelters (99%).1,9

Estimates of Family Homelessness: What You See is What You Get Despite their ongoing use, many argue that PIT and HMIS data underreport the extent of family homelessness across the U.S., and, in particular, the number of children in families who are homeless.10 This occurs for several reasons. First, HUD’s definition of homelessness does not include families who are living doubled-up, staying temporarily with friends or relatives, or living in motels or other temporary places, although such circumstances are common among homeless families, who are seldom visible on the street and exhaust all available resources before they are counted among the 99% of sheltered families in PIT counts.11 For example, in their most recent State of Homeless‑ ness in America report, the National Alliance to End Homelessness (NAEH) reported a 0.07% increase in the number of poor rental households (those who experience severe cost burden in maintaining their rents) and an unchanging number of people in poor households living doubled up with family and friends.12 Similarly, the 2014 United Way of Michigan report on Asset Limited Income Constrained Employed (ALICE) families revealed that 40% of Michigan households struggle on a day to day basis to pay for

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essentials such as housing, food, health care, child care, and transportation.13 These data support the belief that for every one family experiencing literal homelessness (that is, staying in a shelter or uninhabitable place as defined by the Homeless Emergency Assistance and Rapid Transition to Housing [HEARTH] Act),14 five other families face  imminent risk of homelessness.11,15 Families seeking shelter in private agencies (including some religious and non-profit organizations) that are not HUD-supported, and hence not required to collect HMIS data, may also blend into communities unnoticed.16 As a result, those who are seen and counted likely represent only the tip of a large and looming iceberg of housing instability among American families.

Addressing Causes of Family Homelessness Even if more reliable approaches to counting the number of homeless families develop, there is still the matter of addressing the unique issues and circumstances of families experiencing homelessness, most of which have remained consistent over the past three decades. For example, in its first report on hunger, homelessness, and poverty in America’s cities in 1986, the U.S. Conference of Mayors Task Force on Hunger and Homelessness noted that families seeking emergency shelter in the nation’s 25 largest cities increased 20% the year after new HUD initiatives had been put in place.17 Shelters serving homeless families reached capacity in 72% of those cities and were turning families away, many of whom were women with children escaping domestic violence.18 Connections between interpersonal trauma and violence and family homelessness are well supported in the literature.19–24 Domestic violence (DV), in particular, remains one of the leading causes of homelessness and housing instability for women and girls today.25,26 Children in families experiencing homelessness and housing instability have higher than average exposure to abuse and neglect and witness violent events more often than their housed peers.27 Women and girls in homeless families with a history of trauma are especially vulnerable to sexual abuse and trauma by family members and, later, by domestic partners; boys are at greater risk for poor school performance, sexual risk taking, and engagement in criminal activities.28 There is also evidence that chronic and severe violence, limited support networks, and poor interactions with those in positions to aid them predict ongoing housing insecurity among single female-headed family households.19 Consequently, many mothers experiencing trauma fail to seek help or try to avoid detection.29 Repeated exposures of trauma and violence manifest in ongoing cycles of family violence, the development of trauma-related health conditions, chronic housing instability, family disruption, and impaired social networks.30–32

A Case in Point Detroit, hit hard by increased job loss and unemployment, home foreclosures and evictions, lack of affordable housing, and higher costs of living over the past five years is among the major cities challenged by family homelessness.1 In 2014, the Detroit Homeless Action Network of Detroit (HAND)—the lead entity for the Continuum of Care (COC) in the city—reported a total of 16,201 people experiencing homelessness.33 Of these, 4,866 (30%) were homeless adults and children in families, with children

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representing more than half that total (2,742). Predominantly, families were made up of single female African American (95%) adults with children (81%) experiencing homelessness for the first time (48%). Identified reasons for homelessness, in order of prevalence, included eviction, lack of affordable housing, job loss, domestic violence, and underemployment.33 The HAND report represents a compilation of data collected by 29 city organizations and agencies participating in Detroit’s HMIS and is not a complete count of the homeless population in Detroit.33 Nor does HAND data reflect the number of families entering DV programs since they are prohibited under the 2005 Violence Against Women Act from using HMIS, even if unique identifiers are used in place of names.34 Homeless families escaping trauma and violence in DV shelters are therefore absent in larger census counts. When DV shelters are unable to accommodate more families seeking safe shelter or are inaccessible to them, families may take shelter in more mainstream shelter facilities that, though encouraged to be “trauma-informed,” cannot legally record the very reason they are there.35 Thus, the all-too-common reason women and children experience homelessness is rendered invisible.

Summary Current methods for collecting and reporting data about the nation’s homeless provide estimates of overall numbers but are biased in favor of counting individuals who are seen and/or sheltered. Families who are precariously housed or living in DV or private shelters are not included in PIT and HMIS counts and thus remain undercounted. Data collected on families that are counted fail to capture trauma and violence histories and other critical information that may underlie their trajectories into homelessness in the first place, putting them at risk for future homelessness and health risks. Recommendations. Finding the best approaches to quantify and address issues underlying family homelessness is imperative if we are to develop interventions aimed at family homelessness resolution and prevention. That is, even if we get the numbers right, there is still a pressing need to align policies and programs with the real needs of those they serve. We must address the data dilemma in family homelessness so that resources are appropriately allocated to this highly vulnerable but largely invisible population. Expanding HUD’s definition of homelessness to include families who are unstably housed and counting families living in DV shelters will address the full magnitude of trauma and violence that prevail across many of the families seeking services. Expanding rehousing and related services to included trauma-informed assessments and interventions will acknowledge and address root causes of housing instability and family disruption. Only then can public health efforts to reduce and prevent family homelessness be accurately implemented and measured.

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