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HOMELESS NEEDS

INTRODUCTION

A large part of most cities' responsibilities is to look out for the less fortunate. In St. Louis, as in other cities, such people come with many afflictions. Some are mentally retarded and poorly equipped to care for themselves without various kinds of social service support. Some are mentally ill, anxious and able to live by themselves, but often only if they are disciplined in taking their medication. Some have physical disabilities. Some have HIV/AIDS. Many are at risk, or actually homeless. And the reality is that often, individuals have multiple burdens that fall into two, three, or four of these categories.

Traditionally, each category of person has been cared for by a mix of local, state and federal government functions, as well as a host of nonprofit and faith-based institutions. Too often, service providers have not had the time, information, or basic means to collaborate with other service providers assigned to the same individual client. The result has been confusion and redundant effort-and sometimes a faulty "safety net."

In recent years, a new attitude has evolved that encourages partnerships and collaborations and the sharing of information. New technology and new organizations are helping make this possible. Most would agree, however, that the effectiveness of this new approach remains unresolved.

THE HOMELESS PROBLEM

Homelessness is a persistent problem nationally and the situation is little different in St. Louis. Lack of education, lower socio-economic standing in the society, psychological problems caused by trauma, war, rape and a host of other causes, inaccessibility to adequate housing: these are just a few of the problems that face people who are at risk of losing their residences and live in dangerous, uninhabitable conditions, are doubled-up and/or are living on the streets.

Calculating a fair estimate of the number of homeless people in the city of St. Louis is difficult; estimates range from a low of 8,000 to 13,000 (see "Needs and Challenges" section). Though definitive numbers are difficult to quantify, the problem of homeless has not improved in recent years, and will in all probability become worse with the continuing implementation of welfare reform. Governments and private agencies often end up providing stopgap measures in the face of complex problems associated with this often-desperate population. Real change in the overall situation is hard to quantify; often, the best that can be hoped for is adequate provision of maintenance services to homeless individuals and families, with the expectation that the families will not fall into even worse situations than they presently find themselves.

In the midst of this otherwise bleak picture, many agencies in St. Louis have been providing important services to the homeless. Special populations, such as veterans, the mentally ill, HIV/AIDS clients, adolescents, families with children, pregnant women, and domestic abuse survivors are being attended to with programs that attempt to adequately address their issues. Improvements, often difficult to manifest in this environment, have occurred, such as a centralized intake system that has been created to more efficiently refer homeless persons to programs which can best serve them, and outreach aimed at the hard to reach homeless, plus a modicum of prevention programs.

Current Services

Homeless Services Network Board (HSNB)

This board represents some 70 social and human service organizations and meets monthly. The HSNB, established in 1985, is an interagency, community-based process designed to address critical components of homeless service delivery; it has eight specific focus groups that concentrate on the delivery of effective, comprehensive services to the homeless. These focus groups include: Prevention and Intervention, Mental Health, Veterans, Legislative, Emergency Shelter, Transitional Housing, Children & Youth and Multi-Cultural Issues. These focus groups help to identify needs and gaps and to prioritize services and funding. While this is an excellent planning mechanism, its usefulness is directly correlated to the data collected.

Housing Resource Center (HRC)

The HRC represents a focal point of the local strategy that identifies, coordinates and evaluates the needs of the homeless population and provides linkages to emergency shelter and community-based service providers. It maintains a directory of transitional and permanent housing in the city of St. Louis. As a central intake unit, the HRC increases the local community capacity to meet the immediate needs of homeless individuals and families by operating a 24-hour Emergency Shelter Hotline. Homeless and at-risk families can use a single published telephone number to access shelter or housing crisis intervention services. The Hotline is staffed with specialists who conduct initial telephone intake interviews and make assessments. This intake process enables the HRC to match a potential client with the most appropriate shelter, supportive, and/or prevention service available.

Staffed by two trained outreach workers, the HRC operates a mobile outreach program for homeless persons living on the street. Their task is to locate, monitor, assess and make referrals for men and women that need shelter. Building rapport and trust with homeless street persons is the primary purpose of the mobile outreach program; the immediate goal is shelter placement, but the long range goal is placement in transitional and then a permanent housing situation with supportive services for their specific needs.

Emergency Shelters

This form of shelter, defined as a safe, clean and structured 90-day service enriched program, serves the purpose of stabilizing homeless individuals and families. During their stay in the shelter, they participate in a needs assessment, with referrals for substance abuse treatment, mental health services, counseling, life skills classes, school enrollment for both parent and child, and other services which will assist them in working toward independent living and permanent housing.

Eleven social service organizations, under contract with the Department of Human Services-Homeless Services Division, provide emergency shelter of the homeless population in the City of St. Louis. Two of the shelters (plus one that is not under City contract) target their assistance to persons with serious mental illnesses. Each of these shelters also has transitional housing programs. They serve mentally ill adult women and men.

Other shelters, which are operated by area charitable organizations and which do not necessarily conform to the "90-day service enriched" standard, serve the general homeless population, as well as special subgroups, such as abused women and homeless children. Their programs vary in size, from small for specialized populations to large for the general population of homeless individuals and families. Directors of each of the city-funded shelters have formed a Shelter Focus Group of the Homeless Services Network Board; attendance at the meetings is mandatory. The group attempts to focus attention on recurrent problems experienced by many of the shelters, such as managing disruptive adolescents and handling the release to shelters of individuals following hospitalization.

The following emergency shelter table summarizes the community resources in the city of St. Louis:

[ Table III-C- 1, EMERGENCY SHELTERS ]

Transitional Housing

Provision of appropriate support services to assist homeless persons to reach independent living is the goal of transitional housing. Many of the enriched services that have been provided in the emergency shelters are continued for a duration of time not to exceed 24 months. A Transitional Housing Screening Board, which is comprised of emergency shelter and transitional housing program case managers and representatives, reviews the client cases of persons who desire to move from emergency shelter to transitional housing, and recommends which program would best suit the client's needs.

Twelve social service organizations, under contract with the City of St. Louis, currently provide transitional housing programs for homeless individuals and families. They continue to provide supportive services and stress the formulation of a client life plan agreement. This agreement places emphasis on self-sufficiency and education, including the completion, if necessary of a GED, and potential further learning, such as vocational education and college is also stressed. Additionally, the agreement assists the clients with increased expertise in employment training and job search methodology, and intensified living skills, with the ultimate goal of preparing transitional housing clients for assuming the responsibilities of permanent housing.

Other transitional living facilities (not all under City contracts) provide an array of various services, such as recovery from addiction to alcohol and drugs, by both men and women (including pregnant and postpartum females and their children) and service to those homeless persons who suffer from HIV/AIDS.

The following transitional housing table summaries the community resources in the city of St. Louis:

[ Table III-C-2, Transitional Housing ]

Permanent Housing

There are three major categories of available permanent housing: (1) public housing, subsidized by the St. Louis Housing Authority, which has a long history of being a troubled agency; (2) Section 8 vouchers; and (3) market rate units. Many nonprofit organizations try to assist homeless clients to secure housing by way of using the Section 8 vouchers. There are, however, two primary problems with Section 8 housing: an increasingly smaller number of landlords will accept these vouchers, and very few larger units are available for use by large families. Market rate housing is beyond the reach of the majority of homeless people, even if they can secure some sort of employment. The homeless population tends to have more minimal job skills than the presently employed residential population. Therefore, given the average wage rate at which they are employed [when they can find employment and travel to it], their ability to afford non-subsidized rents demanded by market rate units is highly questionable.

Affordable housing continues to be in short supply in the City of St. Louis, at least for the working poor and/or persons with disabilities. For the homeless population exiting emergency shelters or transitional housing, market rate housing is not a realistic goal. The St. Louis area needs at least 28,000 more units of affordable housing, according to an estimate by the Center for Budget and Policy Priorities. Of the 181,000 housing units, more than 100,000 were built before 1939, and therefore many of the units are deteriorating, in substandard condition, or are simply unavailable for use by the homeless population.

Permanent Supportive Housing for Persons with Disabilities

Twenty percent of the American population are persons with disabilities. Given adequate accessibility features that they require, many in this subgroup can live in permanent housing without additional services, while others with physical disabilities require some form of supportive services, such as personal attendant services. The housing preference for a great many people with disabilities is non-congregate housing in the community. This is true, as well, of many people who have mental illnesses: most experts believe that only 5-7% of homeless persons need to be institutionalized; the majority can live, with appropriate supportive housing options, in the community. While this preference is the choice of many, several local programs have successfully created congregate housing programs that are comfortable and appropriate to various populations, such as veterans and others with severe psychiatric disabilities.

Conversely, though, there are an insufficient number of community-based treatment service providers. Affordable, appropriate housing that can accommodate persons with severe mental illness is in short supply throughout the nation; in the St. Louis area, about 900 persons who suffer from severe mental illness use residential care facilities, boarding homes, and nursing homes as their permanent housing.

Locally, Shelter Plus Care vouchers have become the primary approach to non-congregate supported housing for homeless people with disabilities. One model, which has been successful, is the Sponsor-based Rental Assistance (SRA) program that serves women in recovery and their families. Another model is the Tenant-based Rental Assistance (TRA) program that allows tenants to seek out their own housing with the use of vouchers.

Paraquad sponsors a large independent living center in the city of St. Louis which has recently assigned a full time staff person to do outreach for people with physical disabilities who are in need of accessible housing, emergency shelter, and supported transitional housing. The involvement of this organization may have greater significance if the St. Louis Housing Authority moves forward with its plans to designate some its elderly/disabled housing as elderly only. For further data concerning current services, see HUD Table 1A.

Needs and Challenges
Despite the array of services, many problems remain. Many people are in a vicious cycle, going from emergency shelters to transitional housing, and then back into emergency shelters, due to insufficient affordable permanent housing in St. Louis City. Like many cities in the country, St. Louis has insufficient funding for the truly adequate provision of all services. Too often, the focus of programs-and funding-for the homeless population has been upon crisis management, rather than prevention, ensuring that people do not enter this population group in the first place. Local policymakers in St. Louis are quite aware of this issue and have been attempting to bring greater resources into the realm of preventative services, while still maintaining a reasonable level of service delivery to those already on the street.

Calculating the actual number of homeless persons in St. Louis is difficult and poses a significant problem faced by quantification of the existing data. There are two major studies on this-the Missouri Association of Social Welfare (MASW) 1996 and 1998 Point-In-Time Study, and one generated by the Homeless Resource Center (HRC); each has generated a different figure. MASW conducts a bi-annual homeless count. It is important to note that this point-in-time study follows a methodology which focuses on the relative percentages of sheltered to unsheltered to hidden populations at a specific point in time. The study indicates that there are some 32,500 persons homeless per day in Missouri, of which 37% are in the Gateway Region (12,025). [The Gateway Region includes primarily St. Louis City and St. Louis County.]

The Homeless Resource Center annual report indicates some 13,863 calls were made to the Emergency Shelter Hotline during 1998. There calls are a combination of calls from individuals needing shelter and those in housing crisis. The St. Patrick Center, an agency with an extensive history of serving the homeless population in St. Louis, reported serving nearing 11,000 homeless people in 1998 (though they clearly served individuals more than once). Most experts agree that there are between 8,000-10,000 homeless persons in St. Louis.

The City of St. Louis faces multiple challenges that need to be addressed:

• Welfare Reform: This national legislation has created much greater stresses on the homeless population and will undoubtedly increase the number of persons who join their ranks. Given that welfare recipients need transportation and childcare services during their job search, this is creating problems for the City of St. Louis Homeless Office. Additionally, with a potentially greater population becoming homeless, the food pantries at churches and nonprofit organizations will experience increased demand for their resources.
• Loss of Affordable Housing: The number of affordable units has substantially diminished in the last five years (since the 1994 study). Many buildings have been demolished rather than being renovated; large numbers of substandard housing have been condemned for occupancy, which creates other kinds of problems; 4-family units have been converted to 2-family townhouses, resulting in a loss of units. The St. Louis Housing Authority is pursuing a plan to convert low-income public housing into mixed income developments. As mentioned elsewhere in this study, federal regulations mandate the removal of large public housing complexes that are no longer financially sustainable. These complexes contain large numbers of uninhabitable units and the Authority is offering housing vouchers to those being displaced. As these Housing Authority policies are implemented, with a concentration on housing for mixed income and working families, St. Louis may find that these policies lead to stability of the Housing Authority but greater homelessness in the community.
• Youth Challenges: The challenge of obtaining housing and other support services for adolescent boys and young mothers in the 15 to 21 age bracket who have wanted to, or had to, find a place separate from the families is becoming more acute. Persons in this age bracket who are homeless are estimated to be between 1.3 million to 1.6 million annually. This issue was addressed in the 1994 study, and unfortunately the problem has become more acute, not less; little substantial progress has been made in this area.

There are other problems as well: those aging out of foster care; the difficulty of maintaining intact families with children; increased discrimination against families with children (in housing -- it's against the law); the stigma of going to school on the homeless bus; the need for after school and curfew centers; the lack of preschool activities for homeless children; and the widespread dilemma of children bearing children.

• Outreach: The Housing Resource Center continues to experience difficulties due to staff turnover, and the inability to properly handle walk-in clients. Homeless persons continue to face the problem of only being referred to shelters in the county or city depending on their last known address. And there is an overall lack of coordination between the various outreach programs.
• Prevention: One of the most critical ongoing problems faced by people in financially desperate circumstances is that, due to an inability to pay utility bills or overdue rent, they may be evicted from their homes and become homeless. Proactive, early intervention and prevention programs, by social service organizations, is critical so that this negative situation does not come to pass. The problem, though, is that there are many groups that might possibly help, but there is insufficient funding, and it is difficult to determine when someone is actually deserving of assistance or not.

Whatever the actual numbers of homelessness, one figure from the Veterans Administration puts the whole issue of homelessness in stark relief: they estimate that there are an additional 5,000 to 6,000 veterans in the St. Louis area at-risk of homelessness. Given this kind of figure, even if it contains a degree of inflation, great emphasis should be placed upon the additional need for prevention. It is important that funding resources be invested in the at-risk population, so that the homeless population does not continue to grow.

• Inmates Released From Prison: Thousands of mentally ill individuals pass through local correctional facilities each year. Upon release they often face multiple challenges including homelessness, unemployment, substance abuse, estrangement from families and friends, and other serious health conditions. The City of St. Louis should begin to develop a plan for community-based care for this special needs population.
• Deinstitutionalization: Releasing persons with mental illness from psychiatric medical facilities was a novel and revolutionary idea in the 1960's, but many of the problems that would be faced by that population were not foreseen at the time. There was the expectation that sufficient resources would be available for community-based treatment providers. Unfortunately, especially for homeless persons in this population, such providers have not been adequate; additionally, many persons who were assumed to be able to support themselves independently have now become homeless, due to their inability to adequately access supportive services. As a result, sufficient service delivery for deinstitutionalized persons with mental disabilities has not kept up with the need. Shelters and programs that are unprepared for coping with these issues are being forced to provide beds and services to this population, thereby causing stress on the whole service delivery system.
• Veterans: Approximately 40% of homeless men are veterans. Most veterans also face problems such as severe mental illness and substance abuse. While the community does provide some transitional housing for this population, the real need is permanent supportive housing with transitional supports.

Recommendations

a) Create transitional living facilities for single males who have been sexually abused.

This is one "special needs" population that has been neglected in the provision of services. Female victims have facilities for their needs, but males who have been sexually abused have been left out of the planning.

b) Increase training of personnel to handle medical emergencies.

Emergency shelters are organized to handle individuals and families who have been living on the street or who have been recently evicted from the homes. Personnel at emergency shelters are often ill-equipped to handle actual crisis emergencies, which involve medically fragile populations -- such as persons with asthma, diabetes, etc. Further, hospital intake workers may be unsure about how to process homeless persons who have medical crisis.

c) Discontinue the "residency requirement" at the Housing Resource Center.

Presently, a person or family requesting services from either St. Louis City or St. Louis County must have proof of their last known residence, in either the city or the county. (Persons who are from outside the area are handled by St. Louis City.) This residency requirement has created a hardship for both homeless persons and providers. The idea of refusing help to someone in a city shelter, because their last known address was in the county, or vice versa, may have made sense when the only significant homeless programs were in the city. Its existence is no longer relevant, now that the city and county have a good working relationship and are both committed to facing the problem.

With an increasing emphasis upon "regionalism", the distinction between the city and county is of little value; a seamless regional solution to what has become a regional problem is more appropriate. Homeless persons should be able to request services from either governmental agency that is most appropriate to their needs.

d) Rehabilitate vacant buildings for use as residential spaces by homeless persons.

St. Louis City is in a paradoxical situation. Due to population loss over the past 30 years, twenty to thirty percent of the housing units in the city are vacant. There are plenty of buildings in the metropolitan area that could be rehabilitated for use by homeless persons for emergency shelters, transitional living situations, or permanent supportive housing. Rather than constructing new dwellings, available funding resources could be better used in the rehabilitation of these buildings for such use.

e) Create more affordable housing in the City of St. Louis

Presently, many homeless persons are caught in a vicious cycle of moving from emergency shelters to transitional housing, and then, at the end of their mandated 24-month stay in those units, are forced to return to emergency shelter. This intolerable situation is created because of insufficient permanent affordable housing in St. Louis. Only special needs populations, such as the mentally disabled, who have Shelter Plus Care units, are given sufficient numbers of units; other homeless persons are subject to being bounced between emergency shelters and transitional housing, due to this shortage.

Several innovative programs are offering alternatives to this approach. One program proposes to unite landlords and community property owners with homeless persons through direct supportive services of case management, rent subsidies, childcare, and family support. Another program requests funds for these supportive services to expand existing permanent housing placement programs, and includes homeless, mentally ill clients.

f) Expand the case management model

There is consensus that all who contact the Housing Resource Center should be assigned case management follow-up support. At the present if a family is sent to a shelter there is, at least in theory, a case manager. Unfortunately, this has not been the case with families requesting prevention support.

g) Refine the role of the Homeless Services Network Board

The almost 70 organizations that constitute the Homeless Services Network Board include a tremendous collective of ideas, skills, and resources. The eight task forces provide a source of collaboration that was previously difficult to imagine. There is now the recognition that the Board needs to do more in the area of long range planning and specific resolution of priority problems. The Executive Committee of the Board should organize a series of retreats, with assistance from a facilitator, for the purpose of defining a specific set of goals, objectives and responsibilities for the years ahead. They should additionally engage in community and public education about the issues of faced by the homeless population.

Resources
Financial support for the homeless programs comes primarily from five sources:

1. Supportive Housing Program: This was around $14 million in the most recent award, a dramatic increase over previous amounts. However, about $11 million of this went to Shelter Plus Care, so some organizations like St. Patrick's actually suffered a setback.
2. Emergency Shelter Grant: $900,000 plus about $300,000 in rollover funds has resulted in $1.2 million for prevention, essential services, and operations.
3. Missouri Emergency Shelter Grant: Around $170,000 has been made available from the Department of Family Services within the Missouri Department of Social Services.
4. Homeless Challenge Grant: This is a discretionary grant in the amount of $140,000, provided by the Missouri Department of Social Services.
5. General Revenue: The City of St. Louis appropriates approximately $775,000 annually which has been used to fund emergency shelter beds in the Christian Service Center, United Methodists Metro Ministry, and the Peter and Paul Community Services, Inc. The latter two are for mentally ill women and men respectively.

Beyond this, Section 8 and Shelter Plus vouchers provide assistance, as does the public housing authority and many private donors.