The TYP held its sixth Public Conversation at 6pm on Wednesday, September 22, 2010 at the Cansler YMCA. The topic was “Who are the Homeless?” Mary Thom Adams, a supporter of the TYP who works in development with Positively Living Park Ridge Harbor, Knoxville’s largest dedicated permanent supportive housing facility, acted as moderator. Dr. David Patterson, Director, Clinical Doctorate Program and Professor in the University of Tennessee, Knoxville, College of Social Work; Stacia West, M.S.S.W., Data Analyst; and Jennifer Lantz, M.S.S.W. Intern delivered a presentation about the homeless population in Knoxville and the Homeless Management Information System (KnoxHMIS), the database used to gather information about people experiencing homelessness in Knox County. The meeting was attended by approximately 45 people and the conversation, once again, was respectful and informative.
[These are my notes combined with material presented by Dr. Patterson and his team. I tried to capture as much of what was said as I could. If I've misrepresented anything here, or left out something you believe to be significant, please mention that in the comments below this post. Please tell us who you are and where you live.]
Attendees included several City Councilpersons: Vice Mayor Bob Becker, Daniel Brown, Duane Grieve, Nick Della Volpe and former Councilman Barbara Pelot. Former Knox County Commissioner Finbarr Saunders was present. My apologies if I’ve missed anyone. The format of this meeting was one hour. The first half hour was used for presentation. The second half hour was for conversation with attendees.
Ms. Adams, in her role as moderator, focused this meeting’s topic on the demographics of homelessness in Knox County. She asked Jon Lawler, TYP director, to introduce the presenters. Lawler said that the reason that people with chronic homelessness are getting into housing and succeeding there is that the service provider community here in Knox County is made up of great partners. UTK’s College of Social Work is one of those partners, and is a critical part of the work our community is doing to end chronic homelessness. A little over five years ago, there was no centralized data collection system to help us get our hands around the issue of homelessness. Now, there is, and KnoxHMIS is a vital tool. Lawler thanked Dr. Patterson for presenting and the audience for attending.
Dr. Patterson: Thanks for taking time to come out. Introduced Stacia West, Data Analyst; and Jennifer Lantz, Grad Student in Social Work. Patterson discussed what Knox HMIS is. The US Department of Housing and Urban Development (HUD) tasked local communities with developing unduplicated counts of clients served at the local level. HMIS is the direct response to that. HMIS analyzes patterns of use of people entering and exiting the homeless assistance system, and evaluates the effectiveness of these systems. Essentially, HMIS documents who the homeless are and how they’re being served in our community. Back in 2004, KnoxHMIS started collecting data. To date, over 20,000 have been entered into KnoxHMIS. All of these are either homeless or on the verge. KnoxHMIS is a collaboration between the University of Tennessee, the Ten-Year Plan, the City of Knoxville, Knox County, and HUD.
KnoxHMIS is used by 12 participating agencies right now. Its web-based secure database and software links these agencies. Individuals must give their permission for their personal information to be entered into HMIS, and compliance is very high. You are only entered in HMIS if you give permission AND you receive services at a participating agency.
KARM (Knox Area Rescue Ministries) is a big part of KnoxHMIS’s success and usefulness here in Knox County. It is unusual for rescue missions to participate in HMIS. Knox is different in that here, the mission is a full partner in our HMIS. That’s good because it improves our rate and quality of information capture and it gives people an incentive to participate in HMIS. KnoxHMIS participants can be given front-of-the-line preference for meals and beds as an incentive to participation.
KnoxHMIS provides a platform for inter-agency collaboration around services provided to shared clients because it allows users to see what services are delivered to a given client by other agencies. The database helps to coordinate case management across the community. It allows case managers to share case notes and track the history of clients’ experience with homelessness. The goal is to make HMIS integral to the way our community provides services and shares information between homeless service providers. That goal is being realized.
Who is Chronically Homeless? The HUD definition: an unaccompanied disabled individual who has been homeless for at least one year or who has had four episodes of homelessness in the past three years. Patterson underscored that it is critical to note the presence of a disabling condition.
Patterson discussed information about chronically homeless individuals as new clients. There has been a decline of people who meet HUD’s definition of chronic homelessness AND who enter the system as new clients. There are others who are “active clients:” they meet the criteria for chronic homelessness and have received services. KnoxHMIS data seems to suggest that homeless services provider agencies are doing a better job of engaging people who are chronically homeless.
The average chronically homeless person in KnoxHMIS is a single, white male age 46, has a high school education, has never been to prison, is from Knox County, reports his primary reason for homelessness as loss of job, is not a military veteran, and reports to be in good health in comparison to other people his age.
The average homeless (not chronically homeless) adult female in KnoxHMIS is a single, white female age 39, from Knox County, has a high school education, has never been to prison, reports her primary reason for homelessness as domestic violence, and reports to be in good health in comparison to other people her age.
The average homeless (not chronically homeless) adult male in KnoxHMIS is a single, white male age 42, from Knox County, is homeless for the first time, has a high school education, has never been to prison, reports his primary reason for homelessness as loss of job, is not a military veteran, and reports to be in good health in comparison to other people his age.
The average homeless child in KnoxHMIS is 8 years old, accompanied by a single mother, and in a family with 1.65 children. The mother’s self-reported primary reason for homelessness is domestic violence
Patterson stated that the idea that most homeless people in Knox County are not from around here is simply incorrect. It is a basic fact is that 79% of the individuals in KnoxHMIS in 2009 are from Knox County or the contiguous counties as per their last permanent address. 59% of them indicate their last permanent address in Knox County. The data in KnoxHMIS undermines the myth that they’re all from somewhere else. Patterson went on to say that KnoxHMIS is asking a slightly different question (What’s the zip code of your last permanent address?) from the one asked in Dr. Roger Nooe’s biennial study (Where are you from?) which many respondents probably interpret as “Where were you born?”
Why do people fall into homelessness in Knox County? Most of the reasons self-reported are related to economic issues. Loss of job, lack of affordable housing, etc., are dominant reasons. With people experiencing chronic homelessness, substance abuse is a more notable reason. If you look at lifetime prevalence of mental illness, 48% in the general population will exp a diagnosable mental illness, and 15% will experience a significant substance abuse issue. Keep this in perspective.
44% of homeless in Knox experience a disability. Disability is a primary characteristic of homelessness.
23% of active clients in KnoxHMIS are employed.
From Jan 1, 2010 to the present, KnoxHMIS data show that 3251 individuals sought services in Knoxville for the first time. 31% of these were children, which is up dramatically. There is a 31% monthly increase in the number of people entering homelessness.
Ms. Adams ended the presentation phase of the conversation and moved it into question and answer.
Dave Gartner: How do you interpret disability type? Patterson: This info is on the handout sheet (as shown below). Disability is not limited to mental illness and substance abuse alone. The following percentages are reported by case managers; they are not self-reported.
|Disability type||Chronically Homeless||Not Chronically Homeless|
|Chronic Health Condition||1.11%||1.06%|
|Both alcohol & drug abuse||0.28%||0.49%|
Vice Mayor Becker: Is 8% homeless vets high or low or comparable to other places? Patterson: Nationally it’s about 12%. That’s been fairly consistent over time.
Question: What percent don’t agree to participate in KnoxHMIS? Patterson: Very few don’t participate. There was initial concern that lots of people would refuse. Our experience shows that non-participation is close to zero. We’ve built in incentives to participation, such as being able to get certain services faster than people who don’t participate.
Councilman Della Volpe: The causes of homelessness right now are mostly economic. If you looked back a year or two before 2008, would you find different kinds of causes? Patterson: I hesitate to speak of this in terms of causality.
Question: Is there any sort of police check to verify criminal history? Patterson: That’s not inherent in HMIS. That is left up to discretion of individual agencies.
Councilman Della Volpe: How do you determine last permanent address? Are you really talking about contiguous counties? Patterson: Yes to the latter: we are talking about contiguous counties. Last permanent address is identified by zip. It’s a HUD question: What is the zip code of your last permanent address?
Councilman Brown: Do you have info on other races, Hispanic? Stacia West: The percentage of Hispanic individuals who enter the system is very small in Knox, probably around 2%. They just don’t come in for services at a very high rate.
Will Donegan: Is anyone in the community trying to organize homeless people into associations? Ginny Weatherstone: I’m not aware of anyone doing that. Julie Winklestein: There are groups doing that online. Bob Becker: I have heard that there are efforts to organize day laborers in Nashville and Memphis.
Vice Mayor Becker: How many of the chronically homeless have a mental illness? Stacia West: 34% have a mental illness.
Joe Minichiello: There is a discrepancy in your data on the handout sheet. Stacia West: We have to deal with null data. That 14% represents a formula that is used to account for null data in KnoxHMIS. Patterson: There’s a box you check for “chronically homeless” and it doesn’t get checked sometimes, and when that happens, that’s “null data.” The information is applicable to clients who specify their status as chronically homeless. Question: Is the null data in the 14% or the other number? Patterson: It is omitted in the 14%. Stacia West: Both are accurate. They’re two different ways of looking at the same information. The percentage is valid as is the raw number. We can give you the data and you can draw your own conclusions. 14% or 896. 247 new, 14% are new.
Question: When it says “not chronically homeless,” what does that mean? Patterson: That refers to the general population of the homeless. Homeless people who are not chronically homeless by definition are members of the general population of the homeless.
Councilman Della Volpe: Is there a number that indicates employability? Patterson: That is a great question. 44% have a disability. Perhaps we should take those out and assess the 56% who do not have a disability. On the other hand, that would assume that disabled individuals can’t work, and that would be wrong.
Question: Once a chronically homeless person is in housing, what are they considered to be? Patterson: They are no longer homeless if they reside in permanent housing, but if they’re still receiving services, they’re still in the system. Question: How will you characterize people who are no longer homeless but still need help? Patterson: We can specify which chronically homeless people have been housed.
Question: What does employment mean? Patterson: It can mean full time employment, odd jobs, collecting cans, any sort of legitimate employment.
Will Donegan: Is anyone studying the relationship between substance abuse in subsidized housing and homelessness? Patterson: We want to study that relationship and applied for a grant to fund that study, but our funding application was unsuccessful. We’re on the edge of proposing another such study. Donegan: There’s a concern among some members of the public that permanent supportive housing for the homeless will enable substance abuse somehow. Patterson: I have taught substance abuse treatment for nineteen years. The best available evidence suggests that people who are actively using substances decrease their substance use when they are in housing, and that trend continues over the duration of their time in housing. Question: Why is that? Patterson: Well, my best guess is that people living on the street want to numb that reality. When people get into housing other things become more important to them.
Question: Isn’t it true that when people with substance abuse issues get into supportive housing that they have fewer other health issues so that they need fewer other services like the kind you get at hospital emergency rooms? Patterson: Yes, and a study conducted in Seattle and recently published in the Journal of the American Medical Association Seattle points to just this fact.
Question: Within the housing first model don’t you usually have case managers to help with issues like substance abuse? Ginny Weatherstone: Yes. That is certainly true in permanent supportive housing as we know it and do it in Knox County. The case manager assists the newly housed individual to address those issues in an appropriate way. They do it together.
Vice Mayor Becker: Most homeless people in your presentation report good health in comparison to other people their age. That is surprising to me. How could that be? Are there data that support that, or is it just self-reported? Patterson: It’s self-reported. But we know that people living on the streets have much higher incidences of indicators of poor health.
Julie Winklestein: Wasserman says that a lot of people who use alcohol and drugs don’t start until they hit the streets. Patterson: That’s possible I don’t know. Question: Maybe when they are first asked, they’re healthier than later. Are they only asked once? Patterson: Yes.
William Donegan: I’m under the impression that Dr. Nooe’s studies have been a real catalyst to the efforts here in Knox County. Patterson: Yes, very much so. Donegan: I wonder if there was a similar interest in studying substance abuse if that would help with that?
Bill Snyder: Did Nine Counties One Vision look at homelessness? Linda Rust: I don’t think there are any other places in the nine counties that were as far along as we were, so I don’t think it was really a part of the whole Nine Counties One Vision Process. Barbara Pelot: I think we were just waking up to the issue at that time.
Question: In the past couple of years, pills have become more commonly abused. Is there any data on that? Patterson: We don’t collect that directly.
Question: I’d like to see a show of hands of anyone who’s actually been homeless or struggled with addiction? (Not many hands are raised.) I did lose a job, became homeless, addicted, and I’ve overcome those challenges and am off the streets. Now, I’m noticing that the causes of homelessness have not actually changed. Can this database be used to help people find a job? Patterson: There are agencies that are actively helping people to seek employment opportunities across the county.
Next meeting: new location
The next public conversation is scheduled to take place from 6-7pm on Wednesday, November 17 at New Harvest Park, located close to Knoxville Center Mall. Deborah Taylor of KCDC will discuss the role KCDC plays in making affordable housing available to people who need it, including people who are leaving the streets and moving into permanent supportive housing. We’ll follow the same basic format as usual. First half hour presentation, second half conversation about the subject. Please plan to attend.