Each year, approximately one percent of the U.S. population, some 2-3 million individuals, experiences a night of homelessness that puts them in contact with a homeless assistance provider, and at least 800,000 people are homeless in the United States on any given night. The population who experiences homelessness is a heterogeneous group, and includes single individuals, families with children, and unaccompanied runaway and homeless youth. While interventions to interrupt and end homelessness may vary across groups, ending homelessness permanently requires housing combined with the types of services supported by programs operated by the U.S. Department of Health and Human Services (HHS).
HHS is the United States government's principal agency for protecting the health of all Americans and supporting the delivery of essential human services, especially for those who are least able to help themselves. As such, the delivery of treatment and services to persons experiencing homelessness is included in the activities of the Department, both in five programs specifically targeted to homeless individuals and in fourteen non-targeted, or mainstream, service delivery programs. The coordination of these services, both within the Department, as well as with our Federal partners who provide housing and complementary service programs, is a critical component of achieving the goal of preventing and ending homelessness.
The U.S. Department of Health and Human Services has developed the Strategic Action Plan on Homelessness to outline a set of goals and strategies that will guide the Department’s activities related to homelessness over the next several years. This strategic action plan serves as the next iteration of the strategic action plan released in 2003, Ending Chronic Homelessness: Strategies for Action, which outlined the Department’s strategy for contributing to the Administration goal of ending chronic homelessness. The intent of this new plan is to refine the goals and strategies of the 2003 Plan to reflect the changing set of challenges and priorities four years after the development of the first plan.
Goal 1: Prevent episodes of homelessness within the HHS clientele, including individuals and families
Goal 2: Help eligible, homeless individuals and families receive health and social services
Goal 3: Empower our state and community partners to improve their response to individuals and families experiencing homelessness
Goal 4: Develop an approach to track Departmental progress in preventing, reducing, and ending homelessness for HHS clientele
U.S.Department of Health and Human Services:
Strategic Action Plan on Homelessness
Strategic Action Plan Framework
Goal 1: Prevent episodes of homelessness within the HHS clientele, including individuals and families
Strategy 1.1 Identify risk and protective factors to prevent episodes of homelessness for at-risk populations
Strategy 1.2 Identify risk and protective factors to prevent chronic homelessness among persons who are already homeless
Strategy 1.3 Develop, test, disseminate, and promote the use of evidence-based homelessness prevention and early intervention programs and strategies
Goal 2: Help eligible, homeless individuals and families receive health and social services
Strategy 2.1 Strengthen outreach and engagement activities
Strategy 2.2 Improve the eligibility review process
Strategy 2.3 Explore ways to maintain program eligibility
Strategy 2.4 Examine the operation of HHS programs, particularly mainstream programs that serve both homeless and non-homeless persons, to improve the provision of services to persons experiencing homelessness
Strategy 2.5 Foster coordination across HHS to address the multiple problems of individuals and families experiencing homelessness
Strategy 2.6 Explore opportunities with federal partners to develop joint initiatives related to homelessness, including chronic homelessness and homelessness as a result of a disaster
Goal 3: Empower our state and community partners to improve their response to individuals and families experiencing homelessness
Strategy 3.1 Work with states and territories to effectively implement Homeless Policy Academy Action Plans
Strategy 3.2 Work with governors, county officials, mayors, and tribal organizations to maintain a policy focus on homelessness, including homelessness as a result of a disaster
Strategy 3.3 Examine options to expand flexibility in paying for services that respond to the needs of persons with multiple problems
Strategy 3.4 Encourage states and localities to coordinate services and housing
Strategy 3.5 Develop, disseminate and utilize toolkits and blueprints to strengthen outreach, enrollment, and service delivery
Strategy 3.6 Provide training and technical assistance on homelessness, including chronic homelessness, to mainstream service providers at the state and community level
Goal 4: Develop an approach to track Departmental progress in preventing, reducing, and ending homelessness for HHS clientele
Strategy 4.1 Inventory data relevant to homelessness currently collected in HHS targeted and mainstream programs; including program participants’ housing status
Strategy 4.2 Develop an approach for establishing baseline data on the number of homeless individuals and families served in HHS programs
Strategy 4.3 Explore a strategy to track improved access to HHS mainstream and targeted programs for persons experiencing homelessness, including individuals experiencing chronic homelessness
Strategy 4.4 Coordinate HHS data activities with other federal data activities related to homelessness
Chapter 1
Overview of the Strategic Action Plan
Introduction
Each year, approximately one percent of the U.S. population, some 2-3 million individuals, experiences a night of homelessness that puts them in contact with a homeless assistance provider, and at least 800,000 people are homeless in the United States on any given night (Burt et al 2001). Persons experiencing homelessness can benefit from the types of services supported by the programs offered by the U.S. Department of Health and Human Services (HHS). Among this population, there are several key subgroups, including:
HHS and Homelessness
The Department of Health and Human Services (HHS) is the United States government's principal agency for protecting the health of all Americans and supporting the delivery of essential human services, especially for those who are least able to help themselves. The Department is the largest grant-making agency in the federal government, and the Medicare program alone is the nation's largest health insurer (http://www.hhs.gov/about/whatwedo.html). The programs and activities sponsored by the Department are administered by eleven operating divisions that work closely with state, local, and tribal governments. Many HHS-funded services are provided at the local level by state, county or tribal agencies, or through private sector and community and faith-based grantees.
HHS’ work in the area of homelessness fits well with the Department’s mission and priorities. The principals that form the philosophical underpinnings of the Secretary’s 500 Day Plan are applicable to persons experiencing homelessness, particularly the first principal which reads “care for the truly needy, foster self-reliance”. Additionally, the Department seeks to further the President’s New Freedom Initiative to promote participation by all Americans with disabilities, including mental disabilities in their communities. One of the goals in the report of the President’s New Freedom Commission on Mental Health, Achieving the Promise: Transforming Mental Health Care in America outlines the need for stable housing as a requirement for enabling individuals and families with mental illness to fully participate in their treatment and their communities. The Department’s focus on homelessness is consistent with this recommendation.
Ending homelessness requires housing combined with the types of services supported by HHS programs. The delivery of treatment and services to persons experiencing homelessness are included in the activities of the Department, both in five programs specifically targeted to homeless individuals and in twelve non-targeted, or mainstream, service delivery programs (see Table 1 below). The targeted programs are much smaller in scope, but are designed specifically for individuals or families who are experiencing homelessness. Mainstream programs are designed to serve those who meet a set of eligibility criteria, which is often established by individual states, but are generally for use in serving low-income populations. Very often, persons experiencing homelessness may be eligible for services funded through these programs. Because the resources available for the mainstream programs are so much greater than the resources available for the targeted homeless programs, HHS has actively pursued an approach of increasing access to mainstream services for persons experiencing homelessness.
Table 1. HHS Programs Relevant to Persons Experiencing Homelessness
Targeted Homeless Programs
Total Program Budget
FY 2006 (millions)
Grants for the Benefit of Homeless Individuals (Treatment for Homeless)
Health Care for the Homeless
Projects for Assistance in Transition from Homelessness (PATH)
Programs for Runaway and Homeless Youth
Title V/Surplus Property*
Mainstream Programs
Total Program Budget
FY 2006 (millions)
Access to Recovery
Child Support Enforcement Program
Community Mental Health Services Block Grant
Community Services Block Grant
Community Health Centers
Family Violence Prevention and Services Grant Program
Maternal and Child Health Services Block Grant
Ryan White CARE Act
Social Services Block Grant
State Children’s Health Insurance Program
Substance Abuse Prevention and Treatment Block Grant
Temporary Assistance for Needy Families
* The Title V/Surplus Property program involves the transfer of surplus federal property from HHS to a homeless assistance provider, and the program does not have a line item budget.
HHS Response to Homelessness: 2001-2006
An Environment for Change. In 2001, the Secretaries of HHS and HUD met and committed to a collaboration that capitalized on the expertise of HHS in service delivery and the expertise of HUD in housing. A leading concern was for the services funded by HHS to be more accessible to eligible homeless persons residing in HUD-funded housing. Subsequently, HHS, HUD and VA explored goals and activities of mutual interest and concluded that collaboration was best achieved by adopting a specific and targeted focus on the issue of long term and repeated homelessness. Concurrently, in 2002, the Administration revitalized the U.S. Interagency Council on Homelessness (USICH) to coordinate the federal response to homelessness across twenty federal departments and agencies, and to create a national partnership at every level of government and the private sector, with the goal of reducing and ending homelessness across the nation. The final development of major significance came in the release of the Administration’s budget for fiscal year 2003, where President George W. Bush officially endorsed ending chronic homelessness as a goal of his Administration.
The Secretary’s Work Group on Ending Chronic Homelessness. In support of the articulated Administration goal of ending chronic homelessness, senior leadership within HHS established a Departmental work group in 2002 and tasked the group with developing a strategic action plan that would articulate a comprehensive approach for enabling the Department to better serve individuals experiencing chronic homelessness. This work group, entitled the Secretary’s Work Group on Ending Chronic Homelessness, comprises senior leadership from seven operating divisions and numerous staff divisions within the Office of the Secretary and has expanded to encompass more offices as the Work Group has matured (see Figure 1).
Figure 1. Members of the Secretary’s Work Group on Ending Chronic Homelessness
In early 2002, the Secretary’s Work Group on Ending Chronic Homelessness was charged with designing a plan to:
The strategic action plan developed by the Work Group, entitled Ending Chronic Homelessness: Strategies for Action , was released in 2003. The purpose of the 2003 Plan was to define the chronically homeless population and itemize the service needs of the population; analyze the response of HHS mainstream assistance programs to these needs; specify outcomes and objectives that would improve the response of mainstream programs to the chronically homeless population; and offer actions the agencies could take that would improve access to and coordination of services. The 2003 Plan has served as the framework for developing and implementing activities across the Department related to chronic homelessness. The general premise of the strategic action plan posits that homelessness is a complex social problem, and ending chronic homelessness requires housing combined with the types of services supported by the programs funded and operated by HHS. The goals outlined within the strategic action plan provided a course of action for the Department to follow in order to improve access to needed health and social services for individuals experiencing chronic homelessness, empower states to improve their response to individuals experiencing chronic homelessness, and to prevent future episodes of homelessness within HHS clientele.
From its inception to the present time, the Secretary’s Work Group has met regularly in order to discuss policy issues related to chronic homelessness, as well as homelessness among families and youth, review progress, and report about key activities occurring in the various operating divisions. The Work Group has developed an activities tracking matrix, which allows agencies to chart homeless-related activities under the specific goals and strategies outlined in the Plan noted above. The matrix provides Work Group members with a way to measure progress towards achieving these goals and strategies and also provides a simple measure of the level of activity within each key area of focus.
Since 2003, the Department has worked in partnership with the states, other federal Departments, and the U.S. Interagency Council on Homelessness to advance the goals outlined in the strategic action plan. As the plan approached its third anniversary, the Work Group collectively reviewed the Department’s progress towards achieving the goals outlined in the plan, and has concluded that significant progress has been made towards certain goals and strategies, where other goals and strategies needed additional focus. Furthermore, though the 2003 Strategic Action Plan focuses solely on the chronically homeless population, the scope of work and focus of the Work Group was actually much broader, and includes activities that focus on homeless families with children, as well as homeless youth. The Work Group concluded that the Department would benefit from a new plan that would provide a framework for future efforts. The intent of this revision is not to usurp or replace the original strategic action plan, but rather to refine the goals and strategies to reflect the changing set of challenges and priorities three years after the development of the first plan.
Key Events Shaping Strategic Action Plan Revision
Between 2001 and 2006, several key events and activities guided the development of the 2007 Plan. First, HHS partnered with HUD, VA, ICH, the U.S. Department of Labor (DOL), and the U.S. Department of Education (ED) to fund nine HomelessPolicy Academies that were designed to bring together state-level program administrators and homeless service providers in order to develop state-specific action plans designed to increase access to mainstream resources for persons experiencing homelessness. Five Policy Academies focused on chronic homelessness, and in response to demand, the remaining four Academies focused on homeless families with children. To date, every state (including the District of Columbia) and U.S. Territory has attended a Homeless Policy Academy. HHS, along with our federal partners, has provided significant technical assistance resources to these jurisdictions to assist them in the implementation of their Policy Academy action plans over the past several years.
Another key effort extending into the states is the work of the ICH to encourage the development of State Interagency Councils on Homelessness as well as state and local ten-year planning processes to end chronic homelessness. As part of the Council’s strategy to create intergovernmental partnerships to end homelessness, Governors of 53 states and territories have taken steps to create a state-level ICH, while over 280 Mayors and County Executives have initiated a ten-year planning process. Currently, many of the states and Territories are leveraging the support and infrastructure of the ICH and the Homeless Policy Academies to strengthen and coordinate their State Interagency Councils on Homelessness, Homeless Policy Academy teams and state and local planning processes that may already be institutionalized through HUD’s Continuum of Care process.
A cornerstone effort of the increased focus on chronic homelessness was the development of the Collaborative Initiative to Help End Chronic Homelessness, also known as the Chronic Homelessness Initiative (CHI), an innovative demonstration project coordinated by the ICH and jointly funded by HUD, HHS (SAMHSA and HRSA) and the VA. Recognizing that homelessness is an issue that cuts across various agencies in the federal government, this unique effort across the Department offered permanent housing and supportive service funding through a consolidated application process. Successful applicants described an integratedand comprehensive community strategy to use funding sources, including mainstream service resources, to move chronically homeless individuals from the streets and emergency shelters into stable housing. Once housed, the residents would be able to access the range of services needed to promote and maintain greater self-sufficiency. The CHI is important because it operationalizes many of the key goals and strategies outlined in both the original and revised strategic action plans; for example, use of interagency partnerships on both local and federal levels, increasing the effectiveness of integrated systems of care, and the use of mainstream resources. In October 2003, 11 grantees received funding for three years, FY 2003-2005. HHS funding totaled $30 million for the three-year period.
Another key event that influenced the Secretary’s Work Group was Hurricane Katrina, which occurred in August 2005. A special meeting of the Secretary’s Work Group was held in September 2005 on this topic. At this meeting, a literature review compiled for the meeting was used to guide discussion pertaining to: the key players during the hurricane; housing and health issues; the impact on the historically homeless; and data pertaining to and lessons learned from previous disasters. Furthermore, agency representatives at the meeting described their experiences providing concrete assistance during Hurricane Katrina. Lessons learned from this disaster have led the Department to carefully consider how HHS should prepare for and respond to homelessness and human service needs in future disasters, and how the structure of the Work Group might be used as a tool for future natural disasters.
Finally, one of the original charges to the Work Group was to “itemize accountability and evaluation processes.” This called for establishing monitoring and evaluation benchmarks pertaining to chronic homelessness. However, the absence of data to inform the Department about a baseline suggested considerable developmental work would be needed before empirical benchmarks could be established. Over the past several years, the ability to demonstrate results towards ending and reducing homelessness in a quantitative fashion has increased, and thus, where the original plan included a recommendation for this work, a more focused effort to develop data and performance measurements will be critical to documenting future success and is a key component to the revised strategic action plan.
HHS 2007 Homelessness Strategic Action Plan
Purpose of Plan. The purpose of the 2007 Plan is to provide the Department with a vision for the future in the form of a formal statement that addresses how individuals, youth, and families experiencing homelessness can be better served through the coordinated administration of Departmental resources. This Plan allows the Secretary to highlight the accomplishments that have been achieved over the past several years, as well as to chart a course for future activities for the Department that builds on the current efforts. The revised Plan covers a five-year time frame, from FY 2007-FY 2012.
Audience for the Plan. The 2007 Plan has both internal and external audiences and thus may be utilized in various ways. The internal audience consists of the HHS operating and staff divisions that have approved the Plan and agreed to implement it as is appropriate to their respective agency/division. For example, the Plan may impact HHS agencies’ strategic and performance plans, program activities, training, data collection/performance measurement, and/or budgets.
The external audience will be wide-ranging, including HHS grantees and other providers of homeless assistance services, participants of the state Homeless Policy Academies, the developers of state/local 10-year plans to end homelessness, participants of HUD’s Continuum of Care process, advocacy/interest groups, Congress/legislative branch, states, researchers, federal partners, and the U.S. Interagency Council on Homelessness.
Approach Used In Developing the 2007 Plan. In order to develop the 2007 Plan, a Strategic Action Plan Subcommittee was formed, consisting of representatives from the various agencies participating in the Secretary’s Work Group. This subcommittee, working in close partnership with the entire Work Group, utilized an iterative process to review recent accomplishments and to develop recommendations for the goals and strategies to be the framework of the 2007 Plan. Throughout the development of the revised goals and strategies, as well as the narrative text of the 2007 Plan, the subcommittee reported to the full Work Group and revised the plan based on the feedback of the full Work Group. The 2007 Plan was circulated throughout the HHS operating and staff division heads prior to being finalized by the Department and made public.
Major Plan Revisions. As a result of the above process, the following major changes for the 2007 Plan were incorporated:
Measuring Work Group Outcomes. The Secretary’s Work Group will continue to meet regularly. Prior to each of these meetings, the operating and staff divisions that participate in the Work Group will be asked to update the activities tracking matrix. This matrix includes key activities that the agencies are implementing related to homelessness and is organized by the goals and strategies outlined in the strategic action plan. Each activity listed in the matrix includes information about the activity, its timeframe, and its outcome or expected outcome. The matrix can then be used as an analytical tool to examine the Department’s progress related to the activities by goal or strategy, as well as by agency. Each updated matrix is distributed to those attending the Secretary’s Work Group meetings. In addition, participating agencies report orally on their key activities at each meeting; meeting minutes are recorded and sent to participants.
The chapters that follow provide further elaboration on various aspects of the 2007 Plan. Chapter two will outline the 2007 Strategic Action Plan in detail, providing examples of activities that might be undertaken in support of the goals and strategies proposed in the Plan. Chapter three highlights what is new in the plan and the rationale for expanding the existing goals and strategies established in 2003. The fourth chapter provides an overview of progress made by the Department towards achieving the goals outlined in the 2003 Plan. Finally, a series of appendices provide supporting information to the strategic action plan. Appendix A provides an overview of the HHS programs that may serve persons currently experiencing, or at risk of, homelessness. A list of departmental homelessness web resources and research reports relevant to homelessness are included as Appendix B. Additional appendices provide a list of commonly used acronyms (Appendix C), a membership list of the Secretary’s Work Group, including the staff list of the Strategic Action Plan Subcommittee (Appendix D), and finally, a crosswalk of the goals and strategies included in the 2003 and 2007 Plans (Appendix E).
Chapter 2
The Strategic Action Plan in Detail
This chapter delineates all the goals and strategies identified in the 2007 Strategic Action Plan. The chapter also provides, under each strategy, a few examples of possible activities the Department could implement in order to fulfill a given strategy. It is assumed throughout this document that no strategies, or activities, will be implemented without seeking and attaining all relevant legislative and/or regulatory changes needed to ensure that all programs within HHS continue to operate within their given authority and mission. It is also assumed that, to the extent the strategies seek to impose any requirements on applicants as conditions of given awards, before doing so, programs will confirm that their authorizing authority and program/administrative regulations permit such imposition of conditions. It is further assumed that no proposals will be implemented without resolving any inherent budget implications.
The goals, strategies, and examples of activities are as follows:
Goal 1: Prevent episodes of homelessness within thehhs clientele, including individuals and families
Strategy 1.1 Identify risk and protective factors to prevent episodes of homelessness for at-risk populations
Examples of Activities:
o Identify and promote the use of effective, evidence-based homelessness prevention interventions, such as discharge,release, or transition planning; intensive case management; access to protection orders, legal assistance and safety planning for victims of abuse; landlord mediation, and family strengthening, along with organizational and cross-organizational level strategies.
o Promote organizational development and horizontal coordination between agencies such as housing, HIV/AIDS services/prevention, mental health and substance abuse treatment and prevention, and criminal justice to provide integrated comprehensive services to prevent homelessness.
o Examine how HHS agencies can synthesize, sponsor, or conduct epidemiological, intervention, and health services research on risk and protective factors for homelessness and identify preventive interventions that could be provided in health care and human services settings that are effective at preventing at-risk persons from entering a pattern of residential and personal instability that may result in homelessness.
o Encourage states and communities to experiment with various approaches to creating a coordinated, comprehensive approach to addressing homelessness prevention (e.g. establish an infrastructure that supports prevention activities, allows flexibility in the use of funds, and fosters the development of systematic relationships between providers and across systems of care).
Strategy 1.2 Identify risk and protective factors to prevent chronic homelessness among persons who are already homeless
Examples of Activities:
o Review and synthesize the published and non-published literature to identify risk factors associated with chronic homelessness and protective factors that reduce the risk for chronic homelessness.
o Examine how HHS can sponsor or conduct epidemiological, intervention, and health services research on risk and protective factors for chronic homelessness and to identify preventive interventions that could be provided in health care and human services settings that are effective at preventing currently homeless individuals from becoming chronically homeless.
o Develop targeted interventions preventing chronic homelessness specifically for use in HHS programs that are serving currently homeless persons, such as PATH, Treatment for Homeless grantees, and Health Care for the Homeless programs.
Strategy 1.3 Develop, test, disseminate, and promote the use of evidence-based homelessness prevention and early intervention programs and strategies
Examples of Activities:
o Sponsor, synthesize, or conduct research and evaluation on interventions that focus on primary, secondary, and tertiary homeless prevention strategies and health treatment regimens, as well as the organization, effectiveness, and cost of such preventive interventions.
o Identify and develop workforce development strategies and program incentives that foster the adoption and implementation of evidence-based homelessness prevention programs and practices.
o Promote the availability of technical assistance and training documents on services and policy issues related to homelessness prevention via internet access, distribution at relevant meetings, and other settings offering instruction on the issue of homelessness, such as SAMHSA’s National Registry of Evidence-Based Programs and Practices (NREPP) and other listings of effective program models.
Goal 2: Help eligible, homeless individuals and families receive health and social services
Strategy 2.1 Strengthen outreach and engagement activities
Examples of Activities:
o Encourage mainstream programs that support outreach and case management to identify individuals and families experiencing homelessness as potentially eligible candidates for these services.
o Identify and promote innovative outreach and engagement activities successfully operating in existing programs, such as mobile health clinics, outreach workers who function as case managers, and innovative clinic-based programs that operate through the Health Care for the Homeless Program and the PATH program.
o Support empirical studies and demonstration projects that develop and test the effectiveness of outreach and engagement strategies for various populations.
Strategy 2.2 Improve the eligibility review process
Examples of Activities:
o Develop tools for providers that simplify or streamline the eligibility review process, similar to the Health Resources and Services Administration (HRSA)-funded publication entitled Documenting Disability: Simple Strategies for Medical Providers, which provides a partnership tool for the Social Security Administration’s Homeless Outreach Projects and Evaluation (HOPE) program, focused on assisting eligible, chronically homeless individuals in applying for Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) benefits.
o Promote the inclusion of homeless assistance programs among the entities conducting eligibility and enrollment functions for mainstream programs.
Strategy 2.3 Explore ways to maintain program eligibility
Examples of Activities:
o Explore state practices related to policies designed to suspend, rather than terminate, Medicaid eligibility for individuals who are institutionalized so that the eligibility process does not need to be initiated over again upon release.
Strategy 2.4 Examine the operation of HHS programs, particularly mainstream programs that serve both homeless and non-homeless persons, to improve the provision of services to persons experiencing homelessness
Examples of Activities:
o Inventory mainstream HHS programs, identifying barriers to access for persons experiencing homelessness, and propose strategies to reduce and eliminate these barriers to services.
o Identify regulatory barriers and other challenges faced by states as they implement their Homeless Policy Academy state action plans to increase access to mainstream resources.
Strategy 2.5 Foster coordination across HHS to address the multiple problems of individuals and families experiencing homelessness
Examples of Activities:
o Continue to use the regularly scheduled meetings of the Secretary’s Work Group on Ending Chronic Homelessness as a means to promote collaboration and coordination across the Department and develop joint activities and approaches to addressing various aspects of homelessness.
o Work with HHS program agencies to ensure that the Department’s disaster planning efforts address the special needs of the elderly, individuals with disabilities, and other vulnerable populations affected by disasters. Where feasible and appropriate in HHS programs, identify ways to mitigate the long-term impact of homelessness as a result of disasters.
o Develop initiatives which can enable NIH research to be linked to pilot projects and programs within HHS to establish the effectiveness of such projects and programs and expand the evidence-base on what works.
Strategy 2.6 Explore opportunities with federal partners to develop joint initiatives related to homelessness, including chronic homelessness and homelessness as a result of a disaster
Examples of Activities:
o Promote joint initiatives through interagency cooperative agreements, pooled funding for special projects or evaluations of mutual interest or benefit.
o Jointly develop policy or program guidance to assure consistency with other Departments’ policies and statutory and programmatic definitions, and/or consider joint issuance of key policy or programmatic guidance, especially where such issuance has the potential of having a significant impact on another Department’s clients and/or grantees.
Goal 3: Empower our state and community partners to improve their response to individuals and families experiencing homelessness
Strategy 3.1 Work with states and territories to effectively implement Homeless Policy Academy Action Plans
Examples of Activities:
o Encourage federal agencies to incorporate language into their program funding guidance that authorizes applicants to use HHS and other federal funds to create and/or support programmatic strategies that formulate an integrated safety net for poor and disabled individuals and families, where appropriate. Language should also include a requirement that provides for the ability to evaluate the effectiveness of the coordinated efforts.
o Support state grantees to seek appropriate HHS funds to support the implementation of their Policy Academy action plans to address homelessness.
o Support state efforts to expand Policy Academy Action Plans to address the needs of HHS clientele including homeless families and individuals at risk of homelessness, particularly youth and victims of abuse.
Strategy 3.2 Work with governors, county officials, mayors, and tribal organizations to maintain a policy focus on homelessness, including homelessness as a result of a disaster
Examples of Activities:
o Encourage national intergovernmental organizations to hold sessions with a homelessness policy focus at their annual and/or winter meetings (e.g., U.S. Conference of Mayors, National Association of Counties, National Conference of State Legislatures, National Governors Association, National Council of State Governments, National Association of State Mental Health Program Directors, etc.).
o Share information with the national intergovernmental organizations that can be used in their newsletters and other communications with their members (e.g., through a homelessness clearinghouse website that provides links not only to relevant HHS programs but also to state and local activities that could serve as “best practice” models).
Strategy 3.3 Examine options to expand flexibility in paying for services that respond to the needs of persons with multiple problems
Examples of Activities:
o Investigate regulatory barriers faced by grantees utilizing HHS funding that impede the ability of grantees to provide timely, comprehensive services to families and individuals experiencing homelessness. Examine options for reducing identified regulatory barriers.
o Identify “lessons learned” from the jointly funded Chronic Homeless Initiative (CHI) pilot program which allowed for pooled funds from mainstream programs and targeted homeless programs to create a collaborative and comprehensive approach to addressing the problems of homelessness.
o Develop and distribute a primer that will help explain what medical, behavioral health, and support services that would benefit individuals who are homeless can be reimbursed by Medicaid.
Strategy 3.4 Encourage states and localities to coordinate services and housing
Examples of Activities:
o Encourage states and communities to establish approaches, such as partnerships, to create a coordinated, comprehensive system of services to address homelessness, including chronic homelessness. Such approaches include establishing an infrastructure that forges systemic relationships among providers for effective client referral and treatment, more effective leveraging of fiscal and human resources, cross-system training, and increased focus on sustainability of activities.
o Encourage applicants’ use of grant funds to support community infrastructure development efforts, including expenses for staff associated with partnership activities, incentive funds, and other funding mechanisms that can support infrastructure development efforts.
o Where feasible, encourage Federal agencies to develop policy or guidance language encouraging states and communities to address the needs of their homeless residents by coordinating services and housing in a comprehensive way.
Strategy 3.5 Develop, disseminate and utilize toolkits and blueprints to strengthen outreach, enrollment, and service delivery
Examples of Activities:
o Continue interagency collaborations between HHS program agencies to develop tools that are designed for use by both homeless service providers as well as individuals who are homeless.
o Complete, disseminate, and promote the use of toolkits developed by agencies (e.g., SAMHSA’s Treatment Improvement Protocol (TIP) #42 Substance Abuse Treatment for Persons With Co-Occurring Disorders, Assertive Community Treatment and Integrated Dual Disorders Treatment, and Permanent Supportive Housing.
Strategy 3.6 Provide training and technical assistance on homelessness, including chronic homelessness, to mainstream service providers at the state and community level
Examples of Activities:
o Continue to maintain jointly-funded collaborations to support state and community partners to implement their homeless Policy Academy action plans (e.g., SOAR Training Initiative, jointly funded HRSA Policy Academy contract, jointly funded SAMHSA Policy Academy Technical Assistance contract, jointly funded ACF Homeless Families Policy Academies).
o Utilize national meetings of HHS grantees to highlight promising practices and other information to help states implement their action plans through workshops, discussion sessions and transfer peer-to-peer learning to mainstream providers.
Goal 4: Develop an approach to track departmental progress in preventing, reducing, and ending homelessness for hhs clientele
Strategy 4.1 Inventory data relevant to homelessness currently collected in HHS targeted and mainstream programs; including program participants’ housing status
Examples of Activities:
o Inventory and compile the data currently collected within the Department relevant to homelessness; domains may include: OPDIV, title of data source; population included; method of data collection; web link to the data source (or directly to data that are publicly available), and strengths and limitations, among others.
o Review data elements relevant to homelessness and housing status currently collected across HHS programs in order to identify opportunities to compare data across programs, gaps in data collection, as well opportunities to link data across administrative systems.
Strategy 4.2 Develop an approach for establishing baseline data on the number of homeless individuals and families served in HHS programs
Examples of Activities:
o Support a research project to begin the exploration of available data that could be used to identify the number of homeless persons currently accessing HHS mainstream programs by investigating which states currently collect housing status data from applicants of Medicaid and Temporary Assistance for Needy Families (TANF), the two largest HHS mainstream programs that may serve individuals or families experiencing homelessness.
o Explore the feasibility of collecting data regarding the housing status or program participants of HHS mainstream service programs.
Strategy 4.3 Explore a strategy to track improved access to HHS mainstream and targeted programs for persons experiencing homelessness, including individuals experiencing chronic homelessness
Examples of Activities:
o Partner with all HHS agencies that support homeless programs and identify incentives and standard policy language that requires recipients of federal funds to document attempts at improved access to mainstream target programs.
o Collaborate with states and local entities to support efforts to document homelessness and share data with HHS as agreed to by partners. Ensure that any agreements developed are feasible and that the response burden does not exceed that which is deemed reasonable and negotiable by all parties.
Strategy 4.4 Coordinate HHS data activities with other federal data activities related to homelessness
Examples of Activities:
o Generate an inventory of all data elements utilized by various agencies in order to establish similarities and differences within each respective system. Compare HHS inventory with the inventory of other Federal agencies, such as HUD.
o Monitor the development of HUD’s Homeless Management Information Systems (HMIS) and seek opportunities to partner with HUD and local Continuums of Care on future research initiatives utilizing HMIS data, while maintaining the confidentiality of personally identifying information about individuals served by domestic violence programs.
o Disseminate the findings and results of HHS data collection efforts with Federal partners and collaborate on efforts to improve data quality on homelessness.
Chapter 3
What’s New in the Strategic Action Plan
Introduction
The primary purpose for the development of the 2007 Strategic Action Plan is to refine the goals and strategies outlined in the 2003 Strategic Action Plan in order to reflect the progress that has been made, and has not been made, in the four years since the development of the initial HHS strategic action plan on homelessness. There are two new elements that represent the greatest departure from the 2003 Strategic Action Plan and deserve to be highlighted for their magnitude and breadth. First, the Department has broadened the scope of the plan to address issues faced by a clientele that encompasses not only chronically homeless individuals, but also homeless families with children and runaway and homeless youth. Second, the Department has added a new goal that focuses exclusively on issues of data and measurement; specifically, the Department’s ability to document progress in preventing, reducing, and ending homelessness for the HHS clientele. This new goal related to data and measurement includes strategies that seek to identify what types of data are needed to measure progress in addressing homelessness, as well as methods by which to obtain this data. It is important to note that while these new goals and strategies will broaden the focus of the Department’s activities related to ending and reducing homelessness, it is not the intention of the Department to retreat from the initial 2003 commitment to help end chronic homelessness. Rather, the expanded scope will reflect the work related to addressing homelessness for families and children, as well as youth, which is already ongoing and critical to the mission of the Department of Health and Human Services, in addition to the Departmental priority to end chronic homelessness.
This chapter will summarize how the two major changes have been incorporated into the framework of the strategic action plan, and will provide the rationale for the expansion of the plan in these two new directions. In addition, this chapter will briefly discuss the other changes made to the strategic action plan that, while not as prominent in the goals-and-strategies framework as the two major changes mentioned above, are significant and warrant highlighting.
Broadening the Plan to Incorporate a Focus on Homeless Families with Children and Youth
The Change
When the Secretary established the Secretary’s Work Group on Ending Chronic Homelessness in 2002, the Work Group was to report recommendations for a Department-wide approach that would contribute to the Administration’s goal of ending chronic homelessness and improve the Department’s ability to assist persons experiencing chronic homelessness. As the title of the 2003 Strategic Action Plan indicates (Ending Chronic Homelessness: Strategies for Action) the focus of the Work Group was on chronic homelessness. For the last three years, however, the Work Group has actively tracked the efforts of numerous components of HHS to improve access to treatment and services for all eligible groups, including chronically homeless individuals, homeless families with children, and homeless youth. While chronic homelessness has remained a priority, the Department has also engaged in other homelessness related activities that affect families with children and youth, who make up a substantial portion of the HHS clientele.
The goals and strategies from the 2003 Strategic Action Plan framework specifically focused on chronic homelessness. For example, the language in Goals 1 and 2 used the terms chronically homeless and chronic homelessness, and the same two terms were also used throughout the different strategies under all three goals. In order to accurately capture the clientele served by all homelessness-relevant HHS programs, the Work Group decided that the plan would have to be broader in scope. Therefore, the goals and strategies were edited to include families and youth, where applicable. In general, phrases such as “chronically homeless individuals” were substituted by “homeless individuals and families” so as to be inclusive of families and children experiencing homelessness, while still including individuals experiencing homelessness, whether chronic or episodic. However, in order to maintain chronic homelessness as a priority, the Work Group highlights chronic homelessness in a few different strategies in the new framework. Additionally, the new Goal 4 (which will be discussed in more detail below) also takes a broader approach and applies to the whole of the HHS clientele, including individuals and families.
The Rationale
Evidence of the growing number of homeless families supports the expanded scope of the Department’s strategic action plan to include homeless families with children. Findings from the research literature show that families are a significant subgroup that warrants specific attention and interventions that may differ from those that are successful in serving homeless individuals.
According to the 1996 National Survey of Homeless Assistance Providers and Clients, 34 percent of all persons using homeless services were members of a homeless family (Burt et al 1999), though more recent studies (Shinn, et. al 1998) estimate that families make up roughly 40 percent of those who become homeless. The U.S. Conference of Mayors Hunger and Homelessness Survey of 23 cities (2006), report that requests for shelter from homeless families increased by 5% over the previous year, with 59% of the 23 cities reporting an increase. For the purposes of this strategic action plan, a homeless family is defined as one or two adults accompanied by at least one minor child who are either not housed or who have had periods during some recent time period during which they lacked housing. A significant body of research documents the broad array of negative health and mental health outcomes experienced by both children and their mothers in association with episodes of homelessness.
Current research indicates that homeless families are more similar to poor housed families than to single homeless individuals (Burt, et al 1999; Bassuk et al 1996). Several studies have compared housed and non-housed low-income families in an effort to document what characteristics or contextual factors influence a low-income family’s probability of experiencing homelessness. While these studies each examine the experiences of homeless families in only one city, and therefore are not nationally representative, the studies report similar results. In general, researchers have found that heads of homeless families have higher rates of victimization, mental illness, and substance abuse along with weaker social networks, less robust employment histories, and lower incomes than the heads of housed low-income families (Bassuk et al 1996; Bassuk et al 1997; Shinn et al 1998). Additionally, homeless heads of household tend to be younger and tend to have younger children than their housed counterparts (Shinn et al 1998; Webb et all 2003).
In considering which families might be at greatest risk for homelessness, one must consider individual characteristics that might indicate a higher chance of experiencing homelessness, such as substance abuse or mental illness; family factors, such as the presence of violence in the home; as well as contextual factors, such as a lack of affordable housing in the community. Other issues related to the causes and consequences of family homelessness, such as a family’s interaction with the child welfare or foster care systems, may be important as the dynamics of children and their parent(s) while they move through the shelter system may not be the same (Park et al 2004). Fifty-five percent of the cities participating in the 2006 Hunger and Homelessness Survey report that families may have to separate in order to be sheltered (U.S. Conference of Mayors 2006). Many studies have documented a large number of single homeless individuals, primarily women, who are parents but are no longer residing with their children (Burt et al 1999). A number of other studies indicate that housing instability in childhood appears to be associated with adolescent homelessness, suggesting that housing stabilization for homeless or poorly housed families may contribute to the prevention of chronic homelessness (Robertson et al 1999; Park et al 2004).
Runaway and homeless youth, defined in the Runaway and Homeless Youth Act as “individuals who are not more than 21 years of age…for whom it is not possible to live in a safe environment with a relative and who have no other safe alternative living arrangement,” may have different needs than homeless youth who are still connected to their families due to runaway and homeless youth’s lack of adult supervision during a homeless episode. Other youth who may be at-risk of homelessness include youth who are aging out of foster care or exiting the juvenile justice system (Farrow et al 1992). After reviewing the range of estimates of the number of homeless youth, Robertson and Toro concluded that youth under the age of 18 may be at higher risk for homelessness than adults (1999).
HHS operates a wide range of programs that may be accessed by homeless families with children and runaway and homeless youth. The following is a list of HHS programs (both targeted and mainstream) that provide services to homeless families:
Expanding the scope of the strategic action plan to encompass family and youth homelessness will formalize the Department’s already ongoing efforts to assist homeless families with children and youth, as well as tie the work of the Department’s agencies closely to the Secretary’s goals and objectives for the Department as a whole.
Adding a New Goal Focusing On Data and Performance Measurement
The Change
The 2003 Strategic Action Plan devoted one strategy (Strategy 2.9) to data and measurement issues, which read as follows: “Develop an approach for baseline data, performance measurement, and the measurement of reduced chronic homelessness within HHS.” While this is an important strategy, a single strategy alone cannot encompass the many data and measurement issues related to homelessness that have been raised within the Department over the past three years. For example, Strategy 2.9 did not address how the Department would measure progress in improving the access to mainstream services for eligible homeless clients. It also did not address how HHS data activities would be coordinated with other federal department’s important data activities related to homelessness, such as the creation and utilization of HUD’s Homeless Management Information System (HMIS). Therefore, an entirely new goal that contains four separate strategies and focuses exclusively on homelessness data issues and how they relate to tracking Departmental success in addressing the problem of homelessness for the HHS clientele was added to the 2007 Plan.
The new goal (Goal 4) was established to develop an approach to track Departmental progress in preventing, reducing, and ending homelessness for HHS clientele. Strategy 4.1 encourages the Department to inventory homelessness related data that is currently collected in HHS targeted and mainstream programs, including the housing status of participants. Strategy 4.2 promotes the development of an approach for establishing baseline data on the number of homeless individuals and families served in HHS programs, whereas Strategy 4.3 relates to developing a strategy by which to track improved access to HHS mainstream and targeted programs for persons experiencing homelessness. The final strategy identifies collaboration with other Federal departments as a critical component of the Department’s homelessness data activities.
The Rationale
In order to measure progress in preventing, reducing, and ending homelessness, the Department needs to have data systems and performance measures at its disposal. It has been the Department’s experience that it does not yet have an established data approach by which to track its success in addressing homelessness. The Work Group believes that devoting an entire goal and set of objectives to data and performance measures related to homelessness will aid in the process of measuring the success of the strategic action plan. There is a growing desire within the federal government to focus on results and to measure success by documenting progress. This perspective can be seen within different HHS operating divisions’ strategic plans. For example, the Health Resources and Services Administration (HRSA) strategic plan for fiscal years 2005-2010 (http://www.hrsa.gov/about/strategicplan.htm) discusses how the agency measures its progress by monitoring a variety of performance measures that are linked to the goals and objectives set out in the strategic plan. In addition to performance measures, the HRSA strategic plan also discusses the need to assess results, program effectiveness, and strategies. Likewise, there should be a Department-wide approach to measuring the effectiveness of the homeless assistance programs, and of the Department’s strategic action plan. This new focus on data and measurement issues may also assist HHS homelessness programs with future Program Assessment Rating Tool (PART) reviews.
Furthermore, the Department has been pursuing a strategy over the past several years of increasing access to mainstream resources for eligible homeless individuals and families. In the 2003 Strategic Action Plan the Work Group outlined sixteen strategies to reduce chronic homelessness, one of which was to “improve the transition of clients from homeless-specific programs to mainstream service providers.” A cornerstone activity under this strategy has been the development and implementation of nine Homeless Policy Academies that were designed to bring together state-level program administrators and homeless service providers in order to develop state-specific action plans designed to increase access to mainstream resources for persons experiencing homelessness. However, the key policy question, “Has HHS been successful at improving access to mainstream service programs?” cannot yet be answered because no baseline data are available. At the federal level, most mainstream programs are not required to collect data related to the number of homeless clients served. This lack of baseline information about the number of homeless individuals and families served in HHS mainstream programs makes it difficult, if not impossible, for HHS to document improvements in access.
There are a number of challenges in developing this kind of baseline data, particularly due to the fact that homelessness is a dynamic state; a person may be homeless today but housed tomorrow, thus causing fluidity in the number of program participants experiencing homelessness at any given point in time. However, further exploration is warranted to improve the Department’s ability to develop measures related to increasing access to mainstream resources for persons experiencing homelessness. It is also important to highlight that these data development efforts are likely to be fruitless if they are not coordinated with our federal partners. As such, Strategy 4.4 emphasizes the importance of coordinating homelessness data activities within HHS with relevant data activities in other federal agencies and Cabinet-level departments such as HUD, VA, DOL, and the USICH. Thus, while the Department will develop its own data strategies internally, it will be paramount to also coordinate our efforts and integrate data across multiple Federal departments.
Additional Changes to the Plan
While the two major revisions discussed in detail above represent the most substantial changes to the plan, other smaller, yet significant changes have been made within the revised goals and strategies of the 2007 Plan. These changes address the following issues:
In addition to broadening the plan to address homelessness experienced by families with children, the new plan also incorporates populations who areat-risk of homelessness. Vulnerable groups who may be at-risk of homelessness include individuals with disabilities, immigrants, persons leaving institutions (e.g., incarceration- including juvenile detention facilities, inpatient care for psychiatric or chronic medical conditions), youth aging out of foster care, frail elderly, persons experiencing abuse, and disaster victims. By including the at-risk population in the Plan, the Department is acknowledging those who may be on the verge of becoming homeless and who could become the next generation of chronically homeless individuals. Specifically, Strategy 3.1 in the new plan highlights the importance of identifying risk and protective factors to prevent episodes of homelessness for at-risk populations. This new strategy was added to the Plan to emphasize the importance of preventing first-time homelessness for at-risk populations (i.e. primary prevention). The inclusion of at-risk populations further acknowledges that effectively preventing chronic homelessness requires the two-pronged strategy of ending the homeless cycle for those who are already homeless, and the prevention of new episodes of homelessness for those who are currently housed, but who are at risk of becoming homeless.
The plan also contains new language and specific strategies about federal agency collaboration to encourage intradepartmental and interdepartmental coordination and collaboration across the federal government. Federal collaboration was included in Goal 4 as a specific strategy for data activities, but a separate strategy was added to Goal 1 in order to encourage federal partnership across all Departmental activities related to homelessness. Strategy 1.6 reads as follows: “Explore opportunities with federal partners to develop joint initiatives related to homelessness and improve communication on programmatic goals, policies, and issues related to homelessness.”
Strategies in the plan were also revised to reflect the second phase of the Homeless Policy Academies. This PolicyAcademyfollow-up includes providing technical assistance to the states and territories around effective implementation of their Action Plans and sustaining their momentum in addressing homelessness in their respective states and territories. In general, the strategies under Goal 2 (to empower our state and community partners to improve their response to individuals and families experiencing homelessness) are related to this second phase of the Homeless Policy Academies.
Finally, disasters are considered as an issue relevant to homelessness, given the devastation caused by Hurricanes Katrina and Rita, and the consequences to those who lost their homes and those who already were homeless before the catastrophe. To this end, a new strategy in the Plan specifically refers to working with state, local and tribal organizations around policies pertaining to homelessness, including addressing homelessness as a result of disasters, the needs of homeless persons before/during/and after a disaster, and ways to assist the new population of temporarily homeless persons due to a disaster.
Progress Made Since 2003
Introduction
The strategic action plan developed in 2003 has served as the framework for developing and implementing activities across the Department related to chronic homelessness. The general premise of the strategic action plan posits that homelessness is a complex social problem, and ending chronic homelessness requires housing combined with the types of services supported by the programs funded and operated by HHS. The goals outlined within the strategic action plan provided a course of action for the Department to follow in order to improve access to needed health and social services for individuals experiencing chronic homelessness, empower states to improve their response to individuals experiencing chronic homelessness, and to prevent future episodes of homelessness within HHS clientele. Since 2003, the Department has worked in partnership with the states, other federal Departments, and the U.S. Interagency Council on Homelessness to advance the goals outlined in the strategic action plan.
In considering the direction of the 2007 Strategic Action Plan, two documents in particular were reviewed carefully: the final report of the National Learning Meeting and the activities matrix of the Secretary’s Work Group. The National Learning Meeting, held in October of 2005, was the capstone meeting of the first seven Homeless Policy Academies. Representatives of fifty-four states and U.S. territories joined federal agency partners, public and private organizations addressing homelessness, and technical assistance providers to showcase innovative approaches that states and territories are implementing, exchange peer-to-peer technical assistance, and renew the states and territories commitment to fully implementing their Homeless Policy Academy action plans. The recommendations of the states and territories were captured in the final report of the meeting and were considered carefully when developing the revised goals and strategies of the 2007 Plan. The second document that was reviewed was the activities matrix developed by the Secretary’s Work Group on Ending Chronic Homelessness. The matrix provides the means by which the agencies and staff divisions within the Department track progress towards achieving the goals outlined in the Plan. By reviewing the activities matrix, the Department can identify where opportunities to move forward exist.
There are two key areas in which the Department can track its progress since 2003: 1) the programs that serve persons experiencing homelessness and 2) the range of research and programmatic activities that have been undertaken since 2003.
HHS Programs That Serve Individuals, Youth, and Families Experiencing Homelessness
HHS operates a range of programs that may serve individuals and families experiencing homelessness. The relevant programs are divided into two categories: targeted homeless assistance programs, which are specifically designed to serve individuals and families who are homeless, and mainstream programs, which are designed to meet broader goals, such as alleviating poverty or providing health care to low-income persons. The budgets of the targeted homeless programs have experienced growth since 2003 (see Table 1), but improving access to mainstream programs remains critical to increasing the Department’s capacity to serve this population.
Often times, individuals or families who are homeless are eligible for, or can access, services provided through mainstream programs. The combined total budget of the targeted homeless assistance programs is less than one percent of the combined total budget of the mainstream programs that individuals or families who are homeless may access (see Table 2). Additionally, utilization of the mainstream programs not only represents a significant funding stream, but also greatly expands the capacity of the Department to provide the necessary services to persons experiencing homelessness. However, barriers to accessing mainstream programs often hinder the engagement of some persons experiencing homelessness (such as a lack of a permanent, fixed address), and a lack of knowledge about engaging persons experiencing homelessness commonly exists within the broader mainstream service provider community. In order to improve the accessibility and take advantage of the funding and capacity available within the mainstream programs, the Department has engaged in a range of strategies to increase access to mainstream resources for persons experiencing homelessness.
Table 2. HHS Budget Growth- Targeted Homelessness Programs FY 2003-FY2006
(all values in millions)
