Voices from the Field Blog: The Human Connection

by Darby Penney
February 17, 2015

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Homeless and Housing Resource Network Contributing Writer Darby Penney writes about New York City’s Hetrick-Martin Institute (HMI) which has focused for more than 35 years on meeting the needs of lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth. Through human connection and cultural activities, HMI makes a difference in the lives of young people, many of whom became homeless after being rejected by their families of origin.

At 3:15 pm every weekday, Annalee Fannan opens the pantry at New York City’s Hetrick-Martin Institute (HMI), and offers up donated clothing, toiletries, and snacks to the lesbian, gay, bisexual, transgender, and questioning (LGBTQ) young people who participate in HMI’s lifesaving services and programs. About 80 percent of these youth are experiencing homelessness or marginally housed, and they can take advantage of the pantry’s showers and laundry facilities, too, and stay for a hot meal at dinnertime. Fannan, the pantry coordinator for HMI’s Homeless Youth Services, gets to know members’ tastes and sense of style, and may put aside certain clothing that matches their personalities, like high-end stylish shoes and gloves. This human connection, as well as the material assistance, makes a difference in the often chaotic lives of the young people, many of whom became homeless after being rejected by their families of origin when they came out as LGBTQ. Others aged out of foster care or ran away from situations where they felt unsafe, only to end up on the streets, with a different set of urgent safety concerns.

“While it’s hard to get an accurate count, some agencies estimate that there are between 3,000 and 5,000 unsheltered youth between the ages of 12 and 24 in New York City annually,” said Fannan. “Yet there are only 250 beds in youth shelters across the city. There are a few emergency housing programs specifically for LGBTQ youth, like those offered by the Ali Forney Center, where people can stay for up to 30 days, and there are some transitional living programs, where people can stay for a year. But these resources aren’t nearly enough. And LGBTQ youth may have difficulties at shelters that do not understand their specific needs and problems. The youth we serve have limited options: many are couch-surfing, staying sporadically with friends, or sleeping on trains. We know of youth who have gotten married or gotten pregnant in hopes of finding better housing. Others use survival sex to find a place to stay, whether for the night or longer.”

While the situation in New York City is critical, the extent of homelessness among youth across the nation—particularly LGBTQ youth—is alarming. There are between 1.6 and 2.8 million young people experiencing homelessness in the United States, according to a report by the Center for American Progress, and a disproportionate number of these identify as LGBTQ: about 40 percent, compared to a rate of 5-10 percent among the general population (Quintana, Rosenthal, & Krehely, 2010). These young people tend to become homeless at very young ages: on average, gay and lesbian youth become homeless in New York City at 14.4 years of age, and transgender youth at 13.5 years. A 2012 national study of services provided to LGBTQ youth experiencing homelessness confirmed these statistics (Durso & Gates, 2012). In addition, 43 percent of youth surveyed said they became homeless when their parents forced them out of the home because of their sexual orientation or gender identity; 32 percent reported being physically, emotionally, and/or sexually abused at home.

It is not surprising, then, that LGBTQ youth experiencing homelessness have very high rates of mental health and substance use problems, violent victimization, suicidal acts, and engage in a range of HIV risk behaviors (Keuroghlian, Shtasel, & Bassuk, 2014). It is important to note that LGBTQ youth are not a homogenous population, and different subgroups have varying needs that must be understood and addressed. As Keuroghian and colleagues (2014) point out, there is a public policy vacuum when it comes to this population: “…an explicitly articulated federal health policy agenda does not yet exist to address homelessness among LGBT youth in the United States.” The Center for American Progress recommends, as a start, that discrimination against these youth should be overtly banned in all federal programs and agencies (Quintana et al., 2010).

Hetrick-Martin Institute is the nation’s oldest and largest LGBTQ youth-serving organization, and has focused for more than 35 years on meeting the needs of at-risk LGBTQ youth in New York City and beyond. For example, HMI’s newest initiative, the Center for LGBTQ Youth Advocacy and Capacity Building, advocates on behalf of LGBTQ youth by influencing policy on local, national, and international levels, while helping to build the capacity of decision-makers, individuals, and institutions that serve this marginalized population. HMI is also the founder and host agency for the Harvey Milk High School, a small, fully accredited public high school run by the New York City Department of Education for at-risk LGBTQ students who were unable to safely complete their education in traditional public high schools. HMI’s Homeless Youth Services offers a comprehensive set of direct services and referrals for youth aged 13 to 24 in an LGBTQ-friendly environment. While HMI does not provide housing, it refers youth to emergency, transitional, and permanent housing providers, and offers an array of supports. The Health and Housing staff, for example, do street outreach at the parks, piers, and other places where LGBTQ youth experiencing homelessness gravitate, working to develop trusting relationships with young people to encourage them to use HMI services.

These services include an after-school program that offers arts and cultural activities, such as dance, film, photography, painting, and theater, which are very popular with members. Tryouts for a production of West Side Story were scheduled the day Fannan and I spoke, and HMI regularly hosts vogueing and ballroom events, which serve as both an outreach tool and entertainment. In addition, HMI’s after-school program (which is open to youth whether or not they are attending school), offers health and human services such as mental health and substance abuse counseling, HIV testing, job readiness and career exploration, and housing referral.

Housing and homeless service providers need training on cultural competency that is specific to LGBTQ youth, Fannan believes. Too many providers— including foster care agencies, housing providers, and behavioral health organizations—are not familiar with the varieties of LGBTQ youth cultures, and this can interfere with serving these young people appropriately. “Providers need to meet these youth where they are,” Fannan said. “There’s a need for more harm reduction programs and staff who understand the lives of these young people.”


Durso, L.E., & Gates, G.J. (2012). Serving our youth: Findings from a national survey of service providers working with lesbian, gay, bisexual, and transgender youth who are homeless or at risk of becoming homeless. Los Angeles: The Williams Institute with True Colors Fund and The Palette Fund.

Keuroghlian, A. S., Shtasel, D., & Bassuk, E. L. (2014). Out on the street: A public health and policy agenda for lesbian, gay, bisexual, and transgender youth who are homeless. American Journal of Orthopsychiatry, 84(1), 66.

Quintana, N.S., Rosenthal, J., & Krehely, J. (2010). On the streets: The federal response to gay and transgendered homeless youth. Washington, D.C.: Center for American Progress. Available at: https://cdn.americanprogress.org/wp-content/uploads/issues/2010/06/pdf/lgbtyouthhomelessness.pdf

For more information about Hetrick-Martin Institute, visit http://www.hmi.org/

Interested in being an HRC Guest Blogger? Email us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Planning Low-Demand Housing for People Living with HIV/AIDS and Experiencing Homelessness

by Darby Penney
January 21, 2015

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Homeless and Housing Resource Network contributing writer Darby Penney describes how the Damien Center in Albany, New York is rebuilding after a devastating fire, expanding its services to include low-demand housing for people living with HIV/AIDS who are experiencing homelessness.

When the Albany (New York) Damien Center, a grassroots support program for people living with HIV/AIDS, lost its building to fire in August 2013, no one envisioned that a vital new service for its members might someday be born out of the ashes. Staff and members struggled to rebuild the sense of safety and community that the Damien Center had provided since 1990, hastily setting up temporary operations in the First Lutheran Church. For months, everyone was in shock, working to slowly replace what was lost and attempting to reconnect with members, many of whom stayed away after the fire damaged the only place where they felt safe. As a new board member, I was in shock, too, trying to provide practical help, but not yet quite clear how I could be most useful.

Months passed with no settlement from the insurance company. While extremely grateful for the church’s hospitality, Executive Director Perry Junjulas felt like the organization was in a holding pattern, unable to plan for the future. Staff, members, volunteers, and board members were traumatized by the many losses, and the strain took a toll on everyone. It was a trying time for our community.

Amidst this uncertainty, Tracy Neitzel, a visionary leader in homeless services in New York’s Capital District, began a conversation with Junjulas about the possibility of branching out to provide low-demand permanent supportive housing for people living with HIV/AIDS. Junjulas was well aware of the desperate need for stable housing among Damien Center members, about 40 percent of whom are homeless or precariously housed. However with no experience administering housing programs, initially this idea seemed like a stretch. But Neitzel, recently retired after 22 years as executive director of Joseph’s House and Shelter in Troy, New York, was persistent and encouraging. A pioneer in harm reduction and Housing First approaches to homelessness, she noted that the Damien Center’s practice of accepting members as they are, without imposing extensive rules, was in sync with low-demand housing models for people experiencing homelessness.

Junjulas, too, recognized the commonality in the approaches and became intrigued by the possibility of redefining the organization’s mission to include housing. “There is a big need for this approach to housing for our members. They struggle with lots of challenges beyond HIV/AIDS, like poverty, mental health, and substance abuse disorders,” he said. “There are other local housing programs for people with HIV/AIDS, but they impose strict rules that many of our members are incapable of meeting, because their lives are often in chaos. Many members are trauma survivors, and these kinds of rules kick up their trauma responses.”

The turning point came when Neitzel arranged for Damien Center board members to tour Hill Street Inn, a low-demand permanent supportive housing program for people unable to deal with rule-bound housing. The building—funded by state and federal money and designed by architect Owen Neitzel, Tracy’s husband—offers 18 studio apartments and two one-bedroom apartments for couples. “We believe in no rules without reasons,” Neitzel said, “and all of our rules are safety-based. People don’t need to be sober to live here; people can smoke in their own apartments, just like anyone else. We find that people often make changes in their behavior when they know it improves their chances of keeping their apartments, because having their own place is very important to them. But we don’t ask people to adhere to rules except those that ensure everyone’s safety.”

The tour opened board members’ eyes to new opportunities. Talking with tenants at the Inn, we saw first-hand the dramatic effect that having a safe place to call one’s own had on people with long histories of homelessness who had trouble with arbitrary rules. We also learned about the intersection of HIV/AIDS and homelessness. The numbers of people living with HIV/AIDS who move into Joseph’s House supported housing is disproportionally high, without any outreach or active recruitment.

As the National AIDS Housing Coalition (NAHC) points out, people experiencing homelessness have higher rates of HIV infection than the population at large, and people living with HIV/AIDS are at greater risk of homelessness than the population at large. NAHC has also demonstrated that “housing assistance is a powerful and cost-effective way to improve HIV health outcomes and prevent new infections” (National AIDS Housing Coalition, 2013).

With the board energized and committed to the new vision, plans moved fast. The insurance company settled and a new property, located close to Albany Medical Center, the regional HIV/AIDS treatment center, is under contract to be purchased. The Damien Center proposes to build a new center there, designed by architect Owen Neitzel, which will include its agency headquarters and program space, as well as 20 units of low-demand permanent supportive housing to serve 22 people living with HIV/AIDS.

New York State’s Homeless Housing and Assistance Program (HHAP) has funds available for capital construction costs. Tracy Neitzel helped the Damien Center prepare and submit a HHAP grant in the fall of 2014; a decision on this grant is expected soon. Beyond capital costs, the major concern is how operating costs will be sustained. The Damien Center will have access to some housing subsidies for eligible people, which recently became available after other local programs closed. Without such subsidies, the monthly rent would not be affordable for people who rely on disability benefits.

Meanwhile, Junjulas has cultivated relationships with neighbors, civic groups, and politicians to educate them about the need for and benefits of the proposed housing project. These efforts have been successful in building strong community backing, including the support of the neighborhood association and Common Council members. The zoning board approved the project, and groundbreaking is anticipated in the spring of 2015. When the program opens, hopefully in spring 2016, it will be the only Housing First model available in Albany for people living with HIV/AIDS.  

National AIDS Housing Coalition (2013). Housing is HIV Prevention & Care (fact sheet). Available at http://nationalaidshousing.org/PDF/FactSheet.pdf

More information about the Albany Damien Center is available at http://www.albanydamiencenter.org/

More information about Joseph’s House and Shelter is available at http://www.josephshousetroy.org/

Interested in being an HRC Guest Blogger? Email us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Child Homelessness: A National Crisis

by Darby Penney
December 11, 2014

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Homelessness and Housing contributing writer Darby Penney interviews Ellen Bassuk, primary author of America’s Youngest Outcasts: A Report Card on Child Homelessness, on the expanding crisis of family and child homelessness. Between 2012 and 2013, the rate of homelessness among children rose by eight percent nationally. Yet most states’ efforts are not sufficient to address the crisis.

“Family and child homelessness is a crisis and it is not getting the attention it deserves,” said Ellen Bassuk, M.D., primary author of America’s Youngest Outcasts: A Report Card on Child Homelessness. The report was released in November 2014 by The National Center on Family Homelessness at American Institutes for Research. Between 2012 and 2013, the rate of homelessness among children rose by eight percent nationally. “That means that 1 in 30 American children—2.5 million—were homeless in 2013,” Dr. Bassuk, founder and former president of The National Center on Family Homelessness, said. “These are historically high rates. In 1988, families accounted for about one percent of people experiencing homelessness; now, it’s about 36 percent.” The report rates each state and the District of Columbia on four dimensions: extent of child homelessness, child well-being, risk for child homelessness, and state policy and planning efforts. As the report shows, the number of children who experience homelessness continues to climb sharply, yet most states’ efforts are not sufficient to address the crisis.

The typical family experiencing homelessness in 2013, according to the report, consists of an African-American mother under the age of 27 with two small children; 51 percent of children who experience homelessness are under the age of six. Domestic violence, sexual abuse, and other types of interpersonal violence are widespread among this group of women; 90 percent have experienced severe trauma. “This young mother is likely to be relatively uneducated and has little opportunity to earn a living wage that could support her family,” said Dr. Bassuk. “And because she is low-income and has young children, she needs but can’t afford, childcare to hold a job. Add to this picture alarming rates of domestic violence, and this woman is behind the eight ball—and so are her kids.”

While progress has been made in recent years in reducing chronic homelessness among veterans and other single adults, Dr. Bassuk said the opposite is true for families. Policymakers tend to under count families experiencing homelessness because the U.S. Department of Housing and Urban Development (HUD) does not count precariously housed or doubled-up families, only those living on the street or in shelters. In addition, programs designed for families experiencing homelessness tend to focus on the needs of the mother and pay less attention to the critical needs of the children. While becoming homeless is potentially traumatizing for people of any age, it is important to recognize that, when young children experience trauma, there is a relatively short window in their developmental process to address the trauma before it becomes a serious problem that affects them as adults.

“We know from the Adverse Childhood Experiences study that childhood trauma has lifelong negative effects on physical and mental health,” said Dr. Bassuk. “These children are typically facing multiple adverse events before they even enter school. Two-thirds of homeless mothers have a history of domestic violence; one-third of them are actively fleeing domestic violence when they become homeless.”

The type of shelters available to families contributes to the destabilizing trauma experienced by children, according to Dr. Bassuk. Family shelters are often large, older houses where the entire family stays in one room. There is no privacy or safe place for children to play, and boys over the age of 12 are often not permitted. If families do not quickly find permanent housing and are forced to remain in the shelter system, 40 to 50 percent of them will break up within five years, with children being sent to live with relatives or placed in foster care, Dr. Bassuk noted. These children face almost insurmountable obstacles as they become adults and are often trapped in a cycle of poverty, ill health, and significant social disadvantages.

To compound the barriers these families face, it is very difficult—if not impossible—for them to become stably housed without access to subsidized housing, according to Dr. Bassuk. Yet the amount of subsidized housing available has actually gone down at the same time that the need has skyrocketed.

“Family homelessness is exploding because the demographics of the family have changed,” Dr. Bassuk said. “There’s a rise in female-headed households and poverty, an expansion of the low-wage economy, lack of affordable housing, increased levels of violence against women, and cuts in human service programs. Family homelessness consolidates all of our society’s gender issues in one place.”

So what can and should be done to deal with this expanding national crisis? “One thing we know is that housing is essentia,l but not sufficient to make a difference for these families,” Dr. Bassuk said. “We not only need housing, but we also need services for these kids and moms, and we need services for them in the shelters and afterwards.” While some advocates believe that children who experience homelessness should use mainstream mental health and support services, Dr. Bassuk said that does not work. It is unrealistic, she believes, to expect stressed-out homeless families to navigate the fragmented human service system to try to get help for their traumatized children at the same time they are trying to find stable housing and employment. “Six months to a year in a shelter without supportive services is a very long time in the life of a toddler,” Dr. Bassuk said. “These kids need services now!”


America’s Youngest Outcasts: A Report Card on Child Homelessness. (2014). Waltham, MA: The National Center on Family Homelessness at American Institutes for Research. Available at: http://www.homelesschildrenamerica.org/.

A summary fact sheet of the report’s findings is available at http://new.homelesschildrenamerica.org/mediadocs/275.pdf.

State rankings are available at http://new.homelesschildrenamerica.org/mediadocs/276.pdf.

Interested in being an HRC Guest Blogger? Email us at HomelessPrograms@samhsa.hhs.gov.


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Voices from the Field Blog: Winter Weather Preparations for Those Living Unsheltered

by Darby Penney
November 14, 2014

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Homelessness and Housing contributing writer Darby Penney discusses the onset of winter weather and what many cities have instituted in response to tragic deaths from hypothermia and other cold-related conditions to temporarily enhance access to shelter when the temperature falls.

Living on the street can be daunting and dangerous at any time of the year, but in many parts of the country, the onset of winter weather can quickly make this a potentially lethal circumstance. In response to tragic deaths from hypothermia and other cold-related conditions, many cities have instituted Code Blue programs to temporarily enhance access to shelter when the temperature falls.

In New York City, for instance, the Department of Homeless Services initiates Code Blue when the temperature falls to 32 degrees or lower, or if there are sustained winds or periods of intense snowfall. While a Code Blue is in effect, twice the usual number of street outreach vans are deployed to help locate people in need and offer them rides to shelter, assess them for medical needs, and provide warm clothing and food. In addition, people may access any of the agency's shelters and drop-in centers without going through the usual intake process. Many cities have similar programs, although the instigating weather conditions, rules, and available services vary from place to place.

But some people do not live in places with Code Blue programs, or, for a variety of reasons, may choose not to come into shelter. In some localities, people who are under the influence are not welcome to enter shelters, even during emergency weather conditions. But across the country, homelessness service providers, volunteers, and generous citizens have come up with ways to help unsheltered people survive frigid temperatures.

In Buffalo, New York, volunteers Jesse and Kristen Dixon recently founded the Code Blue Relief Mission in October 2014 to collect and distribute blankets, coats, sleeping bags, and other winter gear to people living outside. The Dixons formerly volunteered with an organization that served a similar mission but closed down last year. Realizing that people experiencing homelessness in Buffalo would otherwise go without this service this winter, the couple rallied friends, family members, and community volunteers to make sure these needed supplies are collected and distributed. Inspired by his father, a Vietnam veteran, Jesse Dixon started volunteering in order to help veterans experiencing homelessness and felt that direct outreach to individuals living on the streets of Buffalo was the best way he and his family could help. Code Blue Relief Mission has a drop-off point at a parking garage near the stadium during every Buffalo Bills home game, which brings in much-needed clothing and gear. They also solicit donations from citizens, churches, and other organizations. The group collaborates with local homeless service providers, as well as volunteers, to locate people experiencing homelessness who could benefit from their services, and they distribute the donated supplies to people living on the streets, underpasses, and other outdoor locations during evenings and weekends. Kristen Dixon said, "For me, it's very personal; it warms my heart to be able to help somebody. Basically, you hand somebody a blanket and you might be changing their lives. You don't know their story or what they've been through, but you know at that moment you were able to help them."

Chris Krager, Executive Director of Samaritan House, a homeless shelter and transitional housing program in Kalispell, Montana, also believes in encouraging local people to reach out and offer to help their neighbors who are homeless during the winter. Samaritan House, located in Montana’s remote Flathead Valley, hosts a blog, Homeless in the Flathead, which mixes inspirational reflections, the stories of people who have experienced homelessness, and requests for specific items to be donated. “Every year around this time, I post an article on the blog asking people to be neighborly, to look out for their neighbors who are homeless and cold and to help them out,” said Krager. “If people feel uncomfortable approaching a homeless person, I ask them to let me know where I can find the person, and I’ll go talk to them myself.” He also knows from experience where many of the established camps are, and drops by to offer people access to Samaritan House. It helps to bring presents, he said, noting that he always brings a blanket, a coat, some socks, or similar items when trying to establish a rapport with an individual.

During the winter, Samaritan House uses roll-away beds to help accommodate more guests than usual, going from 62 beds to 99 beds, and is still within the fire code occupancy limits. Some people are reluctant to come in during the cold, Krager said, because they currently use drugs and alcohol (Samaritan House cannot accommodate people who are actively using). For people who remain outdoors in the Montana winter, said Krager, “what’s most important are just common sense things: warm gear like boots, coats, socks, hats, and gloves.” Offering these items to people in a spirit of genuine empathy, he believes, is a way anyone can “look out for their neighbor and help them out in a neighborly way.”

Samaritan House’s blog, Homeless in the Flatland, can be found at http://homelessintheflathead.blogspot.com/

Code Blue Relief Mission has a Facebook page: https://www.facebook.com/pages/Code-Blue-Relief-Mission/801651253229259

Information about the New York City Department of Homeless Services’ Code Blue program is at http://www.nyc.gov/html/dhs/html/communications/code-blue2014.shtml

Interested in being an HRC Guest Blogger? Email us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Rhode Island First State in Nation to Pass Homeless Bill of Rights

by Darby Penney
October 23, 2014

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Homelessness and Housing contributing writer Darby Penney highlights a landmark piece of legislation to provide comprehensive protections against discrimination for individuals and families experiencing homelessness and to educate the public about the reality of life for the most vulnerable people.

In 2012, Rhode Island became the first state in the U.S. to pass a Homeless Bill of Rights, thanks to the leadership of the Rhode Island Homeless Advocacy Project (RIHAP), an organization led by people who have experienced homelessness or are currently experiencing homelessness. Founded by the late John Joyce, who drafted the original bill, RIHAP worked in collaboration with allies in the state legislature, the Rhode Island Coalition for the Homeless (RICH), the state chapter of the American Civil Liberties Union (ACLU), the Interfaith Coalition Against Poverty, and other community organizations to pass the legislation on June 20, 2012. The bill prohibits discrimination based on housing status, stating, “No person’s rights, privileges, or access to public services may be denied or abridged solely because he or she is homeless. Such a person shall be granted the same rights and privileges as any other resident of this state” (Homeless Bill of Rights, R.I. Gen. Laws Ann. §34-37.1-2, 2012).

While the language may sound deceptively simple, the ramifications are far-reaching, according to Jim Ryczek, Executive Director of the Rhode Island Coalition for the Homeless. “The bill is both an educational tool to raise awareness of the ways in which people experiencing homelessness have been discriminated against and a legal tool to enforce people’s rights,” he said. In the tradition of civil rights legislation generally, the goal of the bill was to stop discriminatory practices against a vulnerable group of individuals by ending discriminatory behavior. The intent of the legislation was not to single out any specific group engaging in discriminatory practices, but rather to provide comprehensive protections against discrimination for individuals and families experiencing homelessness within all areas of the public sector.

The campaign for passage of the bill also served as a way to educate legislators and the public about the reality of life for people experiencing homelessness. “Working in partnership with RIHAP members, we developed flyers and talking points for advocates to use in lobbying their legislators and speaking to the press,” Ryczek said. “We focused on explaining that people were asking for equal rights, not ‘special rights.’ In our lobbying and conversations with the media, we highlighted the experiences of discrimination faced by individuals in our community. We all learned much more about what it feels like to experience homelessness in Rhode Island,” Ryczek explained.“ Much of that knowledge is uncomfortable to sit with and unsavory to acknowledge.”

Other jurisdictions have since passed homeless bills of rights, including the states of Connecticut and Illinois in 2013. Illinois’ bill contained language similar to Rhode Island’s, focusing on ensuring that persons who are homeless have the same rights and privileges as all other residents, including the right to use public spaces such as sidewalks, parks, and transportation; equal treatment by government agencies, including the right to vote; and a right to confidentiality and reasonable expectation of personal property (Sheffield, 2013). Connecticut’s law is similar, but also explicitly prohibits “harassment or intimidation from law enforcement officers” (An Act Concerning A Homeless Person’s Bill of Rights, 2013 Conn. Pub. Acts 13-251).

According to the National Coalition for the Homeless (NCH), legislation establishing homeless bills of rights is currently being considered in California, Delaware, Minnesota, Missouri, Oregon, Puerto Rico, Tennessee, and Vermont, as well as in the cities of Baltimore, Maryland, and Madison, Wisconsin. The need for such protective legislation is made more urgent by legislation in localities across the country that effectively criminalize people who are experiencing homelessness by targeting them for their lack of housing and not for their behavior, according to NCH. This includes laws that prohibit feeding people in public places; sleeping in cars, tents, or public spaces; or panhandling.

In Rhode Island, one of the arguments made by opponents of the Homeless Bill of Rights was that it would unleash a flood of lawsuits. This has not happened, according to Jim Ryczek of the Rhode Island Coalition for the Homeless (RICH). In fact, not a single action has been brought under the provisions of the law to date, and RICH encourages Rhode Islanders who feel they have been discriminated against to consider filing a claim. Ryczek offers the following advice to advocates in other jurisdictions: “The laws are important because we currently have no other recourse in our fight to stop discrimination against people experiencing homelessness. Even if few lawsuits are brought, it is vital that these laws are in place to keep the issue visible.”

For more information on organizing to enact a homeless bill of rights in your state or locality, visit the Rhode Island Coalition for the Homeless website at http://www.rihomeless.org/Resources/HomelessBillofRights/tabid/273/Default.aspx

Western Regional Advocacy Project’s Homeless Bill of Rights Campaign site at http://wraphome.org/work/civil-rights-campaign and the Homeless Civil Rights forum of the National Coalition for the Homeless at http://nationalhomeless.org/campaigns/bill-of-right/

Interested in being an HRC Guest Blogger? Email us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Living in her Buick During Law School—Remembering Mimi Kravitz

by Darby Penney
September 22, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney reflects on the life and legacy of a colleague, and how the emergence of Supported Education helps people with psychiatric disabilities meet their goals of higher education.

Recently, while working on a proposal, I did some reading about Supported Education (SEd), a type of program that assists people with psychiatric disabilities in their pursuit of higher education. SEd is a psychiatric rehabilitation intervention that first emerged in the 1980s, along with work at the Boston University (BU) Center for Psychiatric Rehabilitation to develop supported employment (SE) programs. While SE demonstrated success in helping people with psychiatric disabilities choose, get, and keep jobs, many of those jobs were part-time and low-paying, and did not generally lead to real careers that provided enough income for people to become and remain independent (Anthony, 2011). These findings led BU staff to look at the educational needs of people with psychiatric disabilities—in addition to their more immediate employment needs—because of the documented connection between higher educational levels and increased income. This work resulted in the creation of Supported Education as a unique, person-centered approach to supporting people with psychiatric disabilities who wanted to embark on or continue interrupted college careers (Rogers et al., 2010).

My recent encounter with the history and philosophy of Supported Education led me to reflect on the life of my late colleague Miriam (Mimi) Kravitz, who was homeless during much of her undergraduate career and could certainly have benefitted from SEd. Mimi helped found and served as Executive Director of INCUBE, a ground breaking peer-run program in New York City that helped people with psychiatric disabilities develop their own businesses. This began in the late 1980s, a time when many mental health programs still acted as if those of us with psychiatric histories were unemployable. INCUBE was a quirky, incredibly innovative program that served as a nurturing, protective environment for fledgling entrepreneurs who were overcoming challenges related to inpatient hospitalization, drug or alcohol problems, and homelessness.

But in the years before she became the Executive Director of INCUBE, Mimi was, in her own words, “…sick and helpless, and almost alone in New York. As a film and television student at New York University, I ended up sleeping in Union Square… After that, I lost touch with my family and became a child of the system. The experience of Union Square… left me with neurological damage. Hospitalized in the seventies, large doses of Thorazine and anti-psychotics were used. Now, I thank God that people are recognizing that trauma is not psychosis. I was in the system for seven years. I had nine psychiatric hospitalizations… I intermittently lived in welfare hotels and adult foster care.” Mimi goes on to explain that, for much of her early life, the possibility of going to college seemed like a fantasy. “For me, most of my life was spent suffering from isolation and fear. As a small child, I could hear music and voices, which made it difficult for me to learn to read and write” (Kravitz, 1998).

Despite these experiences, Mimi eventually worked her way through college and received a degree in Business Management. Perhaps even more impressive, she later attended and graduated from Brooklyn Law School while she was homeless and living in her Buick in the law school parking lot. I vividly recall an image of Mimi from Peter Stastny’s 1995 film Nerve, in which she described the process of protecting herself, figuring out how to meet her basic needs, and focusing on her studies, knowing that, for her, it would be the way out of poverty, life as a mental patient, and homelessness. A large, exuberant woman with red curls and a hearty laugh, Mimi demonstrated in the film how she made inventive use of a large cape that she wore throughout her law school career. Sometimes it served as a tent-like shelter, sometimes as a changing room, other times as a hiding place, and sometimes just as protection from the winter chill. When I first saw the film almost 20 years ago, I remember feeling that this was a perfect demonstration of the grit, courage, inventiveness, and imagination that allowed Mimi to persevere though many types of hardships and emerge with a law degree that helped lift her out of homelessness.

So, in celebration of Mimi’s life and legacy, I’d like to call attention to the hope and possibilities that programs like Supported Education can offer people who find themselves in circumstances similar to those that Mimi faced in the 1970s and ’80s. People experiencing homelessness today are capable of the kinds of accomplishments that her life exemplifies, and the homelessness services network can help connect people to innovative services like Supported Education that can help them meet their own goals.

For more information on Supported Education, see SAMHSA’s downloadable Supported Education toolkit at http://store.samhsa.gov/product/Supported-Education-Evidence-Based-Practices-EBP-Kit/SMA11-4654CD-ROM.

Anthony, W. A. (2011). Upping the ante. Psychiatric Rehabilitation Journal, 34(3), 175-176.

Kravitz, M. (1998). Legal actions. New York City Voices, fall 1998. Available at http://www.nycvoices.org/article_46.php.

Rogers, E. S., Kash-MacDonald, M., Bruker, D., & Maru, M. (2010). Systematic review of Supported Education literature, 1989 – 2009. Boston, MA: Boston University, Sargent College, Center for Psychiatric Rehabilitation. Available at http://www.bu.edu/drrk/research-syntheses/psychiatric-disabilities/supported-education/.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Promoting Recovery in Homeless Services

by Darby Penney
August 20, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney interviewed Gloria Dickerson, Recovery Specialist at the Center for Social Innovation, on meaningful involvement of people who are current or former service users in the development, implementation, and evaluation of policies in homeless services.

“Recovery doesn’t have an endpoint,” says Gloria Dickerson, Recovery Specialist at the Center for Social Innovation, “it’s an ongoing journey. There’s never a time when you feel like you’ve finally arrived. You spend your life recovering. The good part is that this forces you to develop skills that allow you to keep moving forward in a spirit of hope. Because for me, no matter what, even though there are setbacks, hope is what recovery is all about.” As someone in recovery from trauma, mental illness, physical health problems, and homelessness, Dickerson has a lifetime of lived experience to support her belief in the healing power of hope.

She has also written about concrete actions that can be taken to integrate recovery-focused principles and practices into the homeless assistance network. There is a need for a recovery orientation when serving individuals experiencing homelessness, Dickerson and her co-authors found, because these individuals often face complex, multi-faceted challenges: “Recovery from homelessness overlaps significantly with the process of recovery from mental illness, substance use, and/or traumatic stress… This overlap suggests a significant opportunity for the homeless assistance network to learn from the research, practices, and policies used to promote and implement recovery-oriented care in the areas of mental health, addiction, and trauma care” (Gillis, Dickerson, & Hanson, 2010).

The first step to adapting recovery principles and practices to homeless services is to understand how this concept has been articulated by different systems and to find the commonalities. In 2012, SAMHSA, released a working definition of recovery that did just this, bringing together a variety of stakeholders from the mental health and addictions fields to craft a shared vision that defines recovery as: “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential” (SAMHSA 2012). The working definition is further elaborated through ten guiding principles, the first of which is hope, which is viewed as the “catalyst of the recovery process.”

Dickerson believes that homeless service providers can fan the flames of hope by recognizing that people using services “need to direct and be in charge of our own recovery. Providers need to let clients know what they are doing right, because success breeds success. When you see me succeeding, tell me, encourage me!” Providers also need to recognize the extent to which the people they serve have experienced trauma, both prior to and because of their homelessness, Dickerson believes. “Being trauma-informed is not an add-on,” she says. “Trauma is at the heart of most clients’ experience and its effects need to be recognized; the resilience that people have developed in the face of trauma needs to be honored.”

Another way the homeless service network can promote recovery is to offer low-demand service models like Housing First, which view housing as a basic human right, not as a reward for being compliant with treatment. These models do not tie housing to other services, take a harm-reduction approach, and do not put conditions on retaining housing that go beyond what would be required of any tenant in the general housing market. This model has been found to be effective in promoting recovery. A recent study showed that people experiencing homelessness and co-occurring mental health and substance abuse diagnoses who were served in Housing First programs had significantly lower rates of substance use than people who received traditional “treatment first” services, and were more likely to remain housed (Padgett et al. 2011).

Consumer integration—the meaningful involvement of people who are current or former service users—in the development, implementation, and evaluation of policies and services is another vital part of creating a recovery culture, according to advocates Laura Prescott and Leah Harris (2007). Providers must ensure that consumers are seen as equal and valued partners in the change process and that their input is taken seriously if organizations are to successfully incorporate recovery principles into every aspect of their operations. Through this process, everyone—staff and people receiving services alike—work through the complicated, messy, but ultimately rewarding and ongoing process of figuring out how to make recovery real on a daily basis. “I have a lot of hope for the future of recovery-oriented services,” says Dickerson. “It helps people take joy in their work when they can walk with people on their recovery journey. It’s a process, and sometimes it’s slow, but the relationship of hope and recovery is vital.”

More information on SAMHSA’s working definition of recovery and its ten guiding principles of recovery is available at http://store.samhsa.gov/product/SAMHSA-s-Working-Definition-of-Recovery/PEP12-RECDEF.

Gillis, L., Dickerson, G., & Hanson, J. (2010). Recovery and homeless services: New directions for the field. Open Health Services and Policy Journal, 3, 71-79.

Padgett, D.K., Stanhope, V., Henwood, B.F., & Stefancic, A. (2011). Substance use outcomes among homeless clients with serious mental illness: Comparing Housing First with treatment first programs. Community Mental Health Journal, 47(2), 227-232.

Prescott, L., & Harris, L. (2007). Moving Forward, Together: Integrating Consumers as Colleagues in Homeless Service Design, Delivery and Evaluation. Rockville, MD: Center for Mental Health Services, Substance Abuse and Mental Health Services Administration.

SAMHSA's Working Definition of Recovery. (2012). Rockville, MD: Publication #PEP12-RECDEF. Substance Abuse and Mental Health Services Administration.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: How’s Nashville Campaign Celebrates First Year’s Accomplishments

by Darby Penney
July 23, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney charts the work that has led up to the inauguration of the How’s Nashville campaign to end chronic homelessness by reaching out to diverse stakeholders and building a sense of common purpose across service systems.

How’s Nashville, a broad-based community initiative to end chronic homelessness, successfully housed and supported 545 formerly homeless individuals in its first year of operation, according to Steven Samra, a member of the city’s Metropolitan Homelessness Commission, which started the campaign in June 2013. Almost 200 people were housed during the first 100 days.

How’s Nashville exceeded expectations by bringing together community partners from diverse sectors—including real estate developers, landlords, mental health and substance abuse service providers, anti-poverty organizations, health care agencies, veterans organizations, educators, and various government agencies—to identify the city’s most vulnerable homeless citizens and meet their needs for housing and wraparound supports.

Working in collaboration with the national 100,000 Homes Campaign, How’s Nashville was kicked off with a three-day effort, called Registry Week, in which teams of staff and volunteers surveyed Nashville’s homeless residents using the Vulnerability Index Service Prioritization Decision Assistance Tool (VI-SPDAT). This instrument grew out of research conducted by Dr. Jim O'Connell for Boston's Healthcare for the Homeless organization, which determined specific health conditions that led to the premature death of homeless persons. The survey reached 469 people in Nashville, of whom 222, or 47%, were identified as vulnerable or at risk of premature death on the streets.

Based on the survey results, a by-name list of those in highest need was compiled, and those individuals were given priority for immediate services using a Housing First approach. This was supplemented by providing the newly housed people with Critical Time Intervention (CTI) through a contract with Centerstone, a major local behavioral health care provider. CTI is a time-limited model of case management that provides the most intensive services during the first three months a person is housed, when people’s adjustment to their new living arrangements is most acute; interactions are scaled back as people become accustomed to their new living situations.

Samra notes that How’s Nashville’s first-year success stands in sharp contrast to an earlier local effort in 2009, which was not successful due to lack of community readiness and organizational collaborations. In one case, 27 residents of a large homeless encampment were successfully housed, and all of them lost their housing within the first year. “Where we failed in 2009 was that we did not have strong community readiness, and resources were not well-aligned to provide the wraparound services people needed,” he said. “We hadn’t raised enough awareness in the community, and services were very siloed.”

By contrast, the work leading up to the inauguration of the How’s Nashville campaign focused on developing a strong team of local leaders who had not necessarily worked together in the past, educating them about the tools and resources needed to make a concerted effort to end homelessness, and building a sense of mission and shared values among the community partners. In addition, there was a grassroots fundraising campaign that quickly raised $75,000 to help with expenses that were not covered by various government funds, which brought more positive media attention to How’s Nashville.

Other important contributions to the success of the campaign included development of a Memorandum of Understanding (MOU) with the city’s Metropolitan Development and Housing Agency to set aside a percentage of HUD Section 8 housing vouchers for people on How’s Nashville’s priority list. In addition, a major local developer was recruited as a campaign partner, and he reached out to other developers, who agreed to donate 1% of new rental units to the campaign.

How’s Nashville succeeded in mobilizing community resources to house people at the rate of 45 per month during its first year, almost tripling the rate from the previous year. Some of those housed in the past year were people who were back on the street after the earlier efforts in 2009. What made this possible? Steven Samra believes that the Metropolitan Homelessness Commission’s ability to reach out to diverse stakeholders and build a sense of common purpose was a vital ingredient. “For the first time in Nashville, this campaign really brought people and agencies together across service systems,” he said. “The energy has been catching!”

What needs still exist? As How’s Nashville continues to move forward in its efforts toward ending homelessness, Samra would like to see the development of peer support services provided by formerly homeless people. “We need to put more emphasis on the intersection between homelessness, recovery, and peer support,” he said.

More information on the How’s Nashville campaign is available at: http://howsnashville.org/

Herman, D. B., & Mandiberg, J. M. (2010). Critical time intervention: Model description and implications for the significance of timing in social work interventions. Research on Social Work Practice, 20(5), 502-508.

Juneau Economic Development Council. (2009). Vulnerability Index: Prioritizing the street homeless population by mortality risk. Retreived from http://www.jedc.org/forms/Vulnerability%20Index.pdf

Kanis, R., McCannon, J., Craig, C., & Mergl, K. A. (2012). An end to chronic homelessness: An introduction to the 100,000 Homes Campaign. Journal of Health Care for the Poor and Underserved, 23(1), 321-326.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Holding Spaces for Care – Trauma-Informed Approaches

by Darby Penney
June 20, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney reflects on the moving testimony of a formerly homeless mother who received trauma-informed services through a SAMHSA treatment for the homeless grant in Albany, the Addiction and Recovery Center for Hope (ARCH) program.

More than 60 local health and human service providers, researchers, government officials, and community members came together in Albany, NY, on June 10, 2014, for a roundtable discussion exploring how findings of the SHIFT study (Service and Housing Interventions for Families in Transition) can be used to change policies and practices to help reduce family homelessness.

The study found that homeless mothers are a highly traumatized and under-served group; 93 percent of participants had a history of trauma, with 81 percent having experienced multiple traumatic events. About half the women met diagnostic criteria for post-traumatic stress disorder (PTSD) at the beginning of the study. The majority met criteria for major depression, and most were survivors of interpersonal violence by family, intimate partners, or other known perpetrators. Their children were also negatively impacted by their mothers’ trauma histories, with 41 percent having physical and/or emotional difficulties at baseline (Hayes et al., 2013).

The SHIFT study, funded by the Wilson Foundation, was conducted in the upstate New York cities of Albany, Syracuse, Rochester, and Buffalo by the National Center on Family Homelessness (NCFH). It identified mothers in emergency shelter, transitional housing, and permanent supportive housing programs and interviewed them three times over a 30-month period. 

The results of this study are consistent with those of an earlier study of factors involved in family homelessness (Bassuk et al., 1997), according to Carmela DeCandia of NCFH. What is new, she said, is the study’s conclusion that unresolved trauma issues—as indicated by severity of symptoms of PTSD—and low self-esteem were the only predictors of continuing residential instability at 30 months into the study.
These findings illustrate the critical need for agencies that serve homeless families to learn about trauma and its impact, along with implementing trauma-informed approaches to service provision. This conclusion was emphasized by the moving testimony of a formerly homeless mother who received trauma-informed services through the ARCH program. After multiple episodes of homelessness, which resulted from struggles with her own emotional distress and her daughter’s suicide attempts, Maria, a single mother, entered the ARCH program. Talking with ARCH staff, she realized for the first time that what she experienced as a child was abuse and that she is a survivor of trauma. Maria and her children moved into a supported apartment program, and with ARCH’s trauma-informed supportive services, she has been able to return to the workforce.

While some in the audience were familiar with the idea of trauma-informed approaches (formerly referred to as trauma-informed care), it was apparently a new concept for most of those who participated in the roundtable. A recent review of the literature found that while trauma-informed care offers a coherent framework for providing homelessness services, the concept remains unclear for many providers and the mechanisms for creating trauma-informed organizational and systems change is not well understood in this field (Hopper et al., 2010).

SAMHSA defines trauma-informed approaches as follows: A program, organization, or system that is trauma-informed realizes the widespread impact of trauma and understands potential paths for recovery; recognizes the signs and symptoms of trauma in clients, families, staff, and others involved with the system; it responds by fully integrating knowledge about trauma into policies, procedures, practices, and settings; and it seeks to actively resist re-traumatization.

Homeless service providers—as well as other human services agencies—can request training and technical assistance on trauma-informed approaches to become a trauma-informed organization and to provide trauma-informed peer support, as well as related issues, through SAMHSA’s National Center for Trauma-Informed Care (NCTIC).

For more information on technical assistance from NCTIC, contact Pam Rainer at prainer@ahpnet.com. To access the SHIFT study, please navigate to this link: http://www.air.org/sites/default/files/SHIFT_Service_and_Housing_Interventions_for_Families_in_Transition_

Bassuk, E. L., Buckner, J. C., Weinreb, L. F., Browne, A., Bassuk, S. S., Dawson, R., & Perloff, J. N. (1997). Homelessness in female-headed families: Childhood and adult risk and protective factors. American Journal of Public Health, 87(2), 241-248.

Hayes, M., Zonneville, M., & Bassuk, E.  (2013). The SHIFT Study: Final Report. Needham MA:  The National Center on Family Homelessness.

Hopper, E. K., Bassuk, E. L., & Olivet, J. (2010). Shelter from the storm: Trauma-informed care in homelessness services settings. The Open Health Services and Policy Journal, 3(2), 80-100.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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Voices from the Field Blog: Peer Support for Veterans Involved in the Justice System

by Darby Penney
May 29, 2014

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Homeless and Housing Resource Network contributing writer Darby Penney highlights the work of MISSION DIRECT VET (Maintaining Independence and Sobriety through Systems Integration, Outreach and Networking-Diversion and Recovery for Traumatized Veterans), which is a treatment program that serves veterans with co-occurring mental health and substance abuse issues.

“Shortly after the opening of the pilot site for our Jail Diversion-Trauma Recovery program, we quickly realized that one of the veterans involved in our program was homeless,” said David Goldstein, a team member of MISSION DIRECT VET in Massachusetts. “So the two of us got in the car and drove over to the local veterans’ shelter. We were introduced to the staff, and after the veteran told his story of how PTSD (post-traumatic stress disorder) contributed to his homelessness and his involvement with the courts, he was welcomed with open arms. The warmth present in the room brought me to tears. This was my first, and certainly not my last, experience with a homeless veteran and a welcoming shelter.”

The MISSION DIRECT VET program began with a single pilot site in Worcester, MA in 2009 that has expanded to two other sites in the state. Its goal is to serve veterans with mental health, substance abuse, and other trauma-related issues who are involved with the criminal justice system in order to divert them from jail into trauma-informed services. Originally funded through a five-year SAMHSA grant, the program continues now with state funding.

MISSION-DIRECT VET is a manualized treatment program for people with co-occurring mental health and substance abuse issues. It is the primary treatment service that is offered, and it is supplemented by 12 months of peer support services and case management. Referrals and linkages to vital community-based services such as veterans’ services, vocational and independent living skills programs, family support, and transitional residence programs are also central to the program.

Veterans are over-represented among people experiencing homelessness (e.g., in 2010, veterans accounted for about 10 percent of the total U.S. adult population and 16 percent of the homeless adult population). The good news is that homelessness among veterans has declined by an estimated 25 percent since 2007, according to the U.S. Department of Housing and Urban Development’s 2013 Annual Homeless Assessment Report. 

The National Alliance to End Homelessness reports that homeless veterans include service members from every era since World War II. While Vietnam-era veterans are at greater risk of homelessness than those from other eras, veterans of recent conflicts are more likely to be more gravely disabled. One recent study found two-thirds of homeless Iraq and Afghanistan veterans were diagnosed with PTSD, a rate far higher than earlier generations of veterans (Tsai et al., 2013).

This is where programs that offer a strong peer support component can be especially helpful. MISSION-DIRECT VET team member David Goldstein is a Vietnam veteran, a trauma survivor, and person in recovery. He provides the veterans who participate in the program with one-on-one peer mentoring, facilitates veterans support groups, and connects veterans to resources in the community. Perhaps most importantly, he listens, sits with people who are in trouble, and offers a non-judgmental perspective of someone who has been through many of the same experiences as the people he serves.

While Goldstein has seen the success stories of many of the veterans who have been through the program, he cautions that there are still areas for improvement. “Veterans who go into homeless shelters are often there, directly or indirectly, because of substance abuse issues with drugs and/or alcohol that are often related to PTSD. Because of the rules of the shelters subsidized by the VA (Veterans Administration), they may be asked to leave due to abusing the very substances that got them there to begin with. To keep these veterans from falling back into homelessness, the protocols for these shelters must change,” he said.

Henry, M., Cortes, A., & Morris, S. (2013). The 2013 Annual Homeless Assessment Report (AHAR) to Congress. Washington, DC: The U.S. Department of Housing and Urban Development, Office of Community Planning and Development.

National Alliance to End Homelessness. (n.d.). Veterans. Washington, DC: National Alliance to End Homelessness. [Website article]. Retrieved from http://www.endhomelessness.org/pages/veterans

National Center for Veterans Analysis and Statistics. (2012). Profile of Sheltered Homeless Veterans for Fiscal Years 2009 and 2010.  Washington, DC: The U.S. Department of Veterans Affairs.Retrieved from http://www.va.gov/vetdata/docs/SpecialReports/Homeless_Veterans_2009-2010.pdf

Tsai, J., Pietrzak, R. H., & Rosenheck, R. A. (2013). Homeless veterans who served in Iraq and Afghanistan: Gender differences, combat exposure, and comparisons with previous cohorts of homeless veterans. Administration and Policy in Mental Health and Mental Health Services Research, 40(5), 400-405.

Interested in being an HRC Guest Blogger? E-mail us at HomelessPrograms@samhsa.hhs.gov.

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