An Excerpt: “The Invisible Homeless: Families and the Permanent Supportive Housing Model”
BY DANIEL MONTOYA AND ANUPAMA JACOB, PH.D.
Daniel Montoya was a 2020 recipient of the Center for Public Justice’s Hatfield Prize. Montoya (Azusa Pacific University ‘20) and faculty advisor Anupama Jacob, Ph.D., researched chronic homelessness among families with young children in their community of Los Angeles County, California.
DISCOVER
Jacqueline, a single mother of two young children, has watched her family’s life drastically shift from one of relative stability and safety to a world of unknowns filled with high stress and instability. A year and a half ago, Jacqueline was working a fulltime, minimum wage job at a grocery market downtown. Though finances were tight, she made enough money to put food on the table and pay rent for a small, cozy one-bedroom apartment. Jacqueline was unable to afford child care beyond what was provided at her children’s after-school program and was glad that her employer offered a schedule that made it possible for her to clock out in time to pick her children up from school.
Everything changed when Jacqueline’s manager told her that the market was closing its doors and that she would soon be out of work. Extremely limited savings combined with no regular income meant that Jacqueline could no longer afford rent and she soon lost her apartment. With no family nearby for support, for the last year and a half, Jacqueline and her children have lived in various emergency shelters while she continued her search for a new job that would make it possible for her to afford her own apartment again. A few years prior to experiencing homelessness, Jaqueline was also diagnosed with major depressive disorder. Her experience with family homelessness over the past year and a half have made her depressive symptoms increasingly difficult to manage, despite the use of prescribed medication.
This fictional account gives voice to an experience familiar to thousands of homeless families in the United States. Families experience different types of homelessness. Temporary homelessness refers to a brief period of homelessness that may be due to factors such as eviction, loss of employment, domestic violence, or natural disasters. Chronic homelessness, on the other hand, describes a period of homelessness of at least one year, or three episodes of homelessness within one year, accompanied by a qualifying physical disability, mental health diagnosis, or substance use disorder. Families, like Jacqueline’s, are considered chronically homeless if an adult or minor head of household meets the definition of a chronically homeless individual.
The United States Department of Housing and Urban Development (HUD) defines a family as “a group of individuals, with or without children, seeking assistance together as a family, irrespective of their age, relationship, marital status, gender identity, sexual orientation, or whether or not a member has a disability.” Family homelessness is not always visible or obvious. Family homelessness is defined by HUD as the lack of “a fixed, regular, adequate nighttime residence or as living in a place not suitable for human habitation; or as living in a publicly or privately operated shelter designed to provide temporary living arrangements (including emergency shelters, transitional housing, hotels and motels funded by federal, state, local, and private programs).”
Though many studies examine family homelessness in the U.S., there is limited research on housing interventions for families with young children experiencing chronic homelessness. This report will focus on families comprised of at least one parent and one young child under the age of 18.
Why Do Families Experience Homelessness?
On a single night in 2019, an estimated 171,670 individuals in families experienced homelessness across the United States. This HUD annual point-in-time count captures all family households with or without children under the age of 18, based on HUD’s definition of family, and includes both sheltered and unsheltered families experiencing temporary or chronic homelessness. Approximately 14,779 of individuals within these families were sleeping on the street or in other places not meant for human habitation. However, it is difficult to complete an accurate point-in-time count for families experiencing homelessness because HUD only includes families living on the streets or shelters and does not count families who are living in “doubled-up” households, where families of one or more adults live with “at least one additional adult— in other words, a person 18 years or older who is not enrolled in school and is not the householder, spouse, or cohabiting partner of the householder.”
“The reasons families experience homelessness are varied and complex.”
The typical homeless family in America is made up of a single mother and two young children. As of 2017, women represented over three-quarters (77.6%) and children five years and younger represented almost half (49.6%) of people experiencing family homelessness. Further, 30 percent of families with children experienced HUD’s definition of chronic homelessness in unsheltered locations, meaning that they lived in places not meant for human habitation: a vehicle, an encampment, or on the street for at least one year. As of 2019, African American families represented 52 percent of all homeless families, and the combination of other racial and ethnic minorities accounted for 12.9 percent. By contrast, 35.1 percent of all homeless families are white.
The reasons families experience homelessness are varied and complex. Factors contributing to temporary homelessness among families include unexpected expenses, layoffs, or evictions. Many families live paycheck to paycheck, and one-fifth of all U.S. jobs do not pay enough to keep a family of four above the poverty line of $26,200 in household income. Roughly 40 percent of American households report that they would be unable to cover a $400 emergency expense. One unexpected crisis or setback can result in the loss of a family’s place of security — their home. Economic challenges such as high rent costs, low wages, and a shortage of affordable housing all contribute to this reality.
Chronic homelessness among families consists of long-term or multiple episodes of homelessness requiring more intensive support to address health and social barriers. Key factors contributing to chronic family homelessness include lack of affordable housing, low socio-economic status, domestic abuse, and poor mental and physical health conditions.
Short- and Long-term Impacts of Homelessness on Children and Families
Homelessness has a dramatic impact on both parents and children, affecting health, educational opportunities for children, and family stability. For children in particular, trauma experienced as a result of family homelessness can have negative effects on their physical, social, and mental health well into adulthood. These impacts are experienced disproportionately by Black families, who are overrepresented in the population of homeless families.
Health
Mothers within homeless families are at a higher risk for experiencing a decline in their physical and mental health. A study examining the characteristics and needs of 220 sheltered homeless mothers in Worcester, Massachusetts, found that 22 percent of women reported having chronic asthma, 20 percent reported chronic anemia, and four percent reported having chronic ulcers. These reported physical illness cases are up to 10 times more than the general population rate. Homeless mothers also experience a variety of mental health conditions. Depression is very common among homeless mothers, along with higher lifetime rates of post-traumatic stress disorder, major depressive disorder, and substance use disorders than the general female population. Fathers within homeless families also experience physical and mental health challenges. A study exploring parenting styles of homeless fathers found that they were at greater risk of psychological distress because of the challenges to provide for their family with their limited financial resources.
The most vulnerable members of homeless families, children, can experience high rates of poor chronic health, hospitalizations, developmental disabilities, and behavioral and emotional problems. A study examining the psychological state of 159 homeless children in comparison with a sample of 62 low-income children living at home in Minneapolis, Minnesota, found that homeless children experience twice as many stressors as children in poor families, leading to higher levels of stress that are associated with mental health and behavior problems. Research also suggests that homeless children have more difficulty with internalizing behaviors (e.g., anxiety, withdrawn behavior, somatic complaints) than children in poor families. When children internalize their behavior, they are at a higher risk of developing psychological disorders, suicidal behavior, and behavioral problems, especially within adulthood.
Educational Opportunities for Children
It is incredibly difficult for students to focus at school when they don’t know where they will sleep that night. A stable home is a significant factor contributing to the educational success of children and youth, and conversely, homelessness contributes to poor educational outcomes for children and youth. State Educational Agencies (SEAs) currently review policies and practices that are considered potential barriers to the educational success of homeless children and youth. SEAs reported that there were over 1.3 million homeless students enrolled in public school systems during the 2016- 17 school year in the U.S. This number only provides a glimpse of children experiencing homelessness as it is limited to those enrolled in public school districts. Children experiencing homelessness are more likely to be chronically absent or to change schools frequently. Studies suggest that children experiencing homelessness have higher rates of stress than poor children who remain housed, which can have a negative impact on their school performance. Across age levels, homelessness impacts children’s academic achievement, including their reading, spelling, and mathematics scores, which are more often below grade level compared to their housed peers.
Economic Mobility and Family Stability
Homelessness exacerbates family instability. Adults within families experiencing homelessness tend to have lower educational attainment and limited job skills, making it difficult to secure and maintain stable employment. The time and energy parents spend seeking employment and permanent housing can overpower their ability to parent and maintain family routines, negatively impacting a family’s sense of stability. There is nothing more detrimental to family stability than parent-child separation. A study examining the extent and characteristics of family separations in families experiencing homelessness across the U.S. found that recurrent and longer shelter episodes among families experiencing homelessness predicted child welfare service involvement, potentially leading to parent-child separation.
Addressing Family Homelessness through Permanent Supportive Housing
Homelessness is detrimental to every member of a family as well as to society as a whole. The factors that contribute to family homelessness are varied. In order to address family homelessness, a strong social safety net must exist. The social safety net is a network of government programs, secular and faith-based nonprofit organizations, houses of worship, and businesses that aid the most vulnerable in society by helping them meet their basic needs during their time of need.
“Homelessness has a dramatic impact on both parents and children, affecting health, educational opportunities for children, and family stability.”
The United States Department of Housing and Urban Development, the federal agency responsible for overseeing and addressing the country’s housing needs, provides various streams of funding to state and local governments as well as to nonprofits to assist homeless individuals and families. This is coordinated at a local level by a Continuum of Care (CoC), which is responsible for “allocating HUD funding for homeless services, county health and social service departments, local public housing authorities, and zoning and permitting authorities.”
Homeless families with children have distinct needs from homeless individuals and often require more tailored and holistic wraparound services. This is especially true for parents who struggle to maintain housing due to things like chronic mental illness or substance use. The provision of affordable housing alone is not sufficient for such individuals who require additional supportive services to help them maintain their housing.
Beginning in the 1980s, the supportive housing model, which provides housing combined with on-site services for individuals with chronic mental or physical health needs, emerged as an effective housing strategy for individuals requiring additional support. Some supportive housing programs are temporary, while others are permanent. The supportive housing model is informed by the Housing First approach, which emerged as an alternative to the linear models in which homeless individuals were required to first participate in short-term residential and treatment programs (e.g. thirty-day intensive substance treatment program) and demonstrate that they were “ready” for housing before they were offered permanent, affordable housing. While the Housing First approach seeks to provide a permanent home to homeless families without requiring completion of programming first, critics argue that it does not prepare families with special needs to live independently or enter the private housing market.
Despite critiques, supportive housing continues to be recognized as an effective housing strategy. As of 2019, the HUD Continuum of Care Housing Inventory Count reports a total of 43,199 family PSH units available for occupancy throughout the country. Currently, local Public Housing Agencies (PHAs) who assist families with affordable housing use waiting lists to target housing assistance to the most vulnerable families experiencing chronic homelessness. Some PHAs have had to close their waiting lists due to the long list of applicants that may reach several years. Unfortunately, this means that many families are not offered a PSH opportunity due to the currently extremely limited availability of PSH units that is not sufficient to support the number of families who are in need and eligible. This report focuses on Permanent Supportive Housing (PSH), in which residents typically lease subsidized housing units without limits on their length of stay along with optional community-based supportive services that tenants may require.
Key Features of the Permanent Supportive Housing Model
The permanent supportive housing model has several key characteristics related to housing, service provision, and choice. Currently, individuals and families who have a qualifying disability and are experiencing chronic homelessness under HUD’s definition are eligible for PSH; however, PSH must prioritize chronically homeless individuals with the longest history of homelessness and most severe service need. PSH provides permanent and affordable housing; tenants pay up to a maximum of 30 percent of their adjusted gross income towards rent, and the remaining balance of rent is paid through a rental subsidy or housing voucher. For individuals without a current income, rental subsidies can typically cover 100 percent of a family’s total rent and adjust once they acquire employment. Individuals can remain in their rental unit as long as they remain good tenants (e.g. meeting landlord/ community expectations, following rules and expectations of the designated complex).
While PSH housing is “permanent” in that there is no time limit for families, the goal of this program is to ultimately help families move towards greater degrees of independence, for example, lower utilization of supportive services as appropriate, increasing their ability to maintain permanent housing. It is important to recognize that a family member within PSH lives with a disability that limits the individual’s ability to live completely independently; therefore, these are families who will likely always need some form of support or service.
PSH is provided as single-site housing or scattered-site housing by government agencies or nonprofit organizations providing homeless services. Single-site housing is a designated PSH housing complex with on-site supportive services, while scattered-site housing provides affordable rental units in the private market accompanied by supportive services offered through off-site community-based agencies and nonprofit organizations. PSH prioritizes the respect for family autonomy – parents can often choose between single or scattered site housing, and while supportive services are strongly encouraged, they are not required as a condition for receiving housing.
“Family homelessness is not always visible or obvious.”
The supportive services offered within PSH are holistic and varied, ranging from mental health treatment and employment services to housing oriented services (i.e. help tenants maintain their ability to remain in the housing they have received). These services are typically coordinated by a case manager in order to help tenants address factors contributing to their homelessness and connect them to resources needed to address their unique needs. Supportive services offered through PSH include, but are not limited to, case management, substance use treatment, mental health counseling, health care, support groups, life-skill training, community activities, and employment assistance.
Funding for PSH is complex and consists of both public and private funding streams. PSH providers at the state and local level often receive funding from federal agencies including HUD, the Department of Health and Human Services, and the Centers for Medicare and Medicaid Services. The Low-Income Housing Tax Credit, one of the most critical programs for creating affordable housing, provides incentives for developers to build affordable rental housing.
A Way Forward: A Healthy Ecosystem for Families Experiencing Homelessness
The case management available to families through PSH promotes family stability by serving as a bridge to supportive services that address complex needs (e.g. mental health counseling, physical therapy, employment assistance). The U.S. Interagency Council on Homelessness reports that 80 to 90 percent of families remain housed within PSH and are much less likely to return to homelessness compared to families experiencing homelessness who did not receive PSH. A literature review of housing and services for families by Bassuk and Geller (2006) found evidence to suggest that homeless families who received housing subsidies combined with case management services were more likely to remain housed following a one to two-year period.
Few studies research outcomes beyond housing stability, contributing to the limited literature on PSH and chronic family homelessness. One 2011 study of chronically homeless families who received PSH in Washington state found that families had fewer service needs and better mental health outcomes such as lower levels of moderate to severe anxiety six months after they originally entered PSH. PSH has also demonstrated success in keeping families together and maintaining family stability. A study examining PSH provided to families involved in the child welfare system and family reunification in New York City (2010) found that over 60 percent of open child welfare cases among families were closed an estimated four months after they entered PSH. Children who were placed in foster care with a goal of reunification were all reunited with their families. Additionally, reports of child abuse and neglect declined within these families.
While stable housing is essential for families to thrive, housing alone cannot address the holistic needs of families experiencing homelessness. PSH plays an important role in this regard by providing affordable housing combined with supportive services to help families in need. The following section will explore the ways in which the PSH model can be strengthened to better meet the needs of families as well as the unique roles, responsibilities, and contributions of civil society institutions, including houses of worship, secular and faith-based nonprofits, and developers in promoting flourishing and stability for families experiencing homelessness.
Read the rest of “The Invisible Homeless: Families and the Permanent Supportive Housing Model,” which includes the research team’s recommendations for addressing family homelessness through public policy and civil society, and a case study of Los Angeles County, California.
Daniel Montoya will graduate in December 2020 with a bachelor’s of social work from Azusa Pacific University (APU) in the city of Azusa, California. He completed his research for The Hatfield Prize during his senior year. Montoya was the Vice President of the Latin American Student Association for the 2019-2020 academic year, an ethnic organization at Azusa Pacific University that offers a forum for fellowship, education, and dialogue to encourage the appreciation of cultural diversity. Simultaneously, he was an intern serving individuals living with chronic homelessness and severe mental illness. Montoya also provides mentorship as a TRiO: Upward Bound Academy leader to first-generation high school students surrounding professional development, academic success, and emotional wellness. A proud Azusa native, Montoya takes pride in his community and has a passion for serving his local school district demonstrated through his mentorship opportunities and previous tutoring experience through the AVID program. Following the completion of his BSW, his goal is to further his education and pursue a master’s of social work.
Anupama Jacob, Ph.D., is an associate professor in APU’s Bachelor of Social Work program, and APU’s interim director of undergraduate research in fall 2019. Jacob earned a Ph.D. in Social Welfare from the University of California, Berkeley. Her research interests center on issues related to poverty and inequality, particularly in the United States. Prior to starting her Ph.D. program, Jacob worked as publications manager at the Center for Social Development, a research and policy center based at Washington University in St. Louis. Her academic experience includes adjunct teaching in the undergraduate social work program at San Jose State University, and teaching assistant positions at the University of California, Berkeley. Jacob is also a commissioner on the Council on Social Work Education’s Commission on Research.
ADDRESS FAMILY HOMELESSNESS IN YOUR COMMUNITY
Inspired by what you’ve read? Consider starting a Political Discipleship group to address family homelessness in your community. The Center for Public Justice’s Political Discipleship is a praxis-based curriculum designed to equip small groups to practice civic engagement and empower them with skills and tools to shape policy and address inequality and injustice in their communities. To learn more about starting a group, visit our website or contact katie.thompson@cpjustice.org.
The Hatfield Prize is made possible through the generosity of the Annie E. Casey Foundation and the M.J. Murdock Charitable Trust. We thank them for their support, but acknowledge that the findings and conclusions presented in these reports are those of the authors alone and do not necessarily reflect the opinions of these foundations.