Symposium Sessions

Keynote Presentation: “Changing homeless and mainstream service systems: Essential approaches to ending homelessness”
Martha Burt, PhD (Urban Institute)

Content: This presentation will describe the conclusions from several studies of community efforts to mobilize mainstream and homeless service systems toward the goal of ending homelessness. Using examples from several communities, it will show how the presence or absence of the following characteristics affect success: 1) top-level commitment of at least a core of relevant public and private actors; 2) a dedicated coordinator with right personality; 3) a history of working together of at least a few of the agencies that you want to involve in system change; 4) resources for the coordinator, for culture change and skills reorientation training, and for creating screening/triage/intake and placement processes; 5) leverage points-inside or outside government; and data to galvanize change and to measure it.

Discussant: Paul Koegel (RAND Corporation)

Keynote Presentation: “Research for what? Thirty years and counting… to what ends?”
Kim J. Hopper, PhD (Columbia University)

We’ve been conducting research on nearly every facet of homelessness for more than 3 decades now. Kim Hopper’s talk will offer of stocktaking of what we've learned over these past 30 years: What do we know now that we didn't before? What about those research results has proven especially useful in shaping policy or practice? And do we need more of it (research) -- and, if so, on what? Are the really durable questions about homelessness -- now the longest period of widespread "official" homelessness in the nation's history -- ones that require more research to answer?

Introduction: Jim O'Connell, MD (Boston Healthcare for Homeless)

Presentation: “On Ending Chronic Homelessness for Single Adults, Families, and Youth: An Overview of the State of the Science ”
Carol L.M. Caton, PhD (Columbia University)

Content: This presentation will focus on an overview of what we know about the numbers and characteristics of single adults, families, and youth who experience long-term homelessness, and the efficacy of interventions to prevent or end homelessness for these three subgroups of homeless people in the United States.

Presentation: “Homelessness, Addiction and Housing Interventions: What We Don’t Know So Far”
Stefan Kertesz, MD, MSc (University of Alabama at Birmingham)

Content: Cross-sectional survey data from the United States suggest that current-year drug and alcohol problems are present among 38% and 46% of homeless persons, respectively, while 45% have a past year nonaddiction mental health problem (the overlap among these conditions is substantial). Developing housing solutions for homeless individuals with complex psychosocial problems is an important challenge facing the over 300 communities planning to end chronic homelessness in the United States. Of special importance, communities must identify practical approaches to both housing and treatment for homeless persons where addiction is the primary problem. One prominent approach, termed Housing First, offers permanent housing without requiring intensive treatment program participation, and has earned national interest, particularly for clients with severe and persistent mental illness. An alternate “linear” model, positions rehabilitative treatment as prerequisite to long-term housing intervention, and is sometimes identified with as the traditional Continuum of Care approach. This presentation will show that where severe addiction is the primary problem, or a major competing problem, the available research data are inconclusive regarding the relative benefit of a Housing First versus a linear approach.

Discussant: Paul Koegel, PhD (RAND Corporation)

Discussant: Rosendo Collazo, DO (Camillus Health Concern)

Presentation: “Shelter Utilization Patterns among the Chronically Homeless and Their Application in the Effort to End Homelessness.”
James D. Wright, PhD (University of Central Florida)

Content: Among pieces of research that have been applied in the effort to end homelessness, none has been more consequential in the last two decades than the studies by Dennis Culhane and associates on patterns of shelter utilization among the homeless. These studies showed that a relatively small fraction of "frequent fliers" (chronic shelter utilizers) comprised overwhelmingly of chronically homeless men consumed a relatively large fraction of the available shelter capacity (and by implication, other emergency services for the homeless). Roughly, 20% of the homeless consume 80% of the shelter nights. The policy implication, which undergirds the national effort to end chronic homelessness in ten years and the recent emphasis on Housing First approaches, is that if one could find acceptable permanent housing for the 20% of chronic shelter users, the need for emergency shelter space might fall to a quarter or a fifth of its current level. My presentation reviews the original Culhane studies in New York and Philadelphia and some more recent efforts to replicate the results in other cities. We also present new data on patterns of shelter use among homeless men in Orlando. All subsequent studies including our own generally confirm the original findings. Some of the policy implications drawn from these results, however, are unwarranted inferences and over-generalizations from what the data actually sustain.

Presentation: “Housing and service models for homeless families: What works for whom?”
Stephanie Geller, EdM (National Center on Family Homelessness)

Content: There is evidence that access to housing vouchers increases housing stability for homeless families; however, the research on the impact of services is more limited.  This session will begin by reviewing the research on the experiences and needs of homeless families and how housing and services help families achieve housing stability and other important outcomes. Next, information on a multi-site research study being carried out in Upstate New York will be presented. This study focuses on how different housing/service models may help different subgroups of families. The session concludes with an interactive discussion of the needs of homeless families in Florida, the housing/service models being implemented across the state, and what research questions service providers most want answered.

Discussant: Beth Weitzman, PhD (New York University)

Presentation: “Direct Access to Housing: A Health Care Based Approach”
Marc Trotz, MPH (San Francisco Department of Public Health)

Content: The presentation will describe how the San Francisco Department of Public Health conceived of and implemented a harm reduction based housing model designed to stabilize and improve the health status of chronically homeless persons struggling with complex medical and behavioral health issues. The main goals of this housing program are to improve the health and well being of this often marginalized population and reduce inappropriate and expensive over-utilization of emergency health care services.

Moderator: Ken Kraybill, MSW

“Homelessness and the foster care system”
Cheryl Zlotnick, RN, DrPH (Center for the Vulnerable Child of Children's Hospital & Research Center at Oakland)

Content: Rather than focusing on reducing chronic homelessness as is the emphasis of current U.S. policy, another approach is to focus on reducing entry into homelessness. The association among homelessness, childhood foster care, mental illness and substance abuse has been reported in many studies - and not just with homeless single adults - but also with homeless families, homeless and runaway teens. This presentation reviews the links of childhood foster care and homelessness and explores the possibility that interventions in the foster care system may help prevent homelessness.

Discussant: Beth Weitzman, PhD (New York University)

Presentation: “Time2Act: An Evaluation of an HIV prevention program for addicted homeless men”
William Darrow, PhD (Florida International University, Robert Stempel School of Public Health)

Content:This presentation will discuss the development, implementation and evaluation of "Time2Act" : an HIV-prevention program for homeless men in substance abuse treatment. The session will cover an introduction of the intersection between HIV, homelessness and substance abuse, and will then discuss a program developed and implemented at Camillus House's residential addiction treatment program. Dr. Darrow will present the results of the pilot program's evaluation, highlighting both problems and successes encountered during the program's implementation. Discussion will cover the program's outcomes, as well as lessons learned along the way. The session shall also include showing portions of the HIV-prevention videos that were written and produced by clients who participated in "Time2Act".

Introduction: Hirut Kassaye (Camillus Health Concern)

Presentation: “Accessing Social Security benefits for homeless adults: A how-to workshop”
Javier Hiriart, MD (Camillus Health Concern)
Cindy Schwartz, MS, MBA(Eleventh Judicial Circuit Criminal Mental Health Project)

Content: This workshop will review approaches and successful strategies that will help homeless adults to access and expedite social security benefits for mental illness and co-occurring disorders as well as other disabilities. First, the training will review the SOAR (SSI/SSDI, Outreach, Access and Recovery) initiative, developed as a federal initiative in an effort to help case managers assist homeless adults with serious mental illnesses and co-occurring disorders with the application process for Social Security disability benefits. These benefits – Supplemental Security Income (SSI) and Social Security Disability Insurance (SSDI) – are among the first steps toward recovery and stability for many people experiencing homelessness. Second, the training will cover simple strategies for for medical providers in documenting disabilities, aimed at briefly explaining and reviewing SSI/SSDI benefits and the application process clients must go through. The talk then proceeds to review methods in which providers can help patients navigate this application process and enhance their chances of success. This is demonstrated via documentation of impairments during routine office visits and encounters as well as by providing some alternative means in which providers can provide extra information to enhance clients’ applications.

Presentation: “Homelessness in Miami: A Manifestation of racial and ethnic disparities”
Karen Mahar (Camillus House, Inc.)
Marvin Dunn, PhD (Florida International University)
Alex Stepick, PhD (Florida International University)

Content: Although Blacks/African-Americans comprise approximately 19% of families in Miami-Dade County, they comprise approximately 63% of the homeless population. This extreme disparity is not unique to Miami, as minorities, and particularly Blacks/African-Americans are disproportionately affected by poverty and homelessness across the country. This workshop will first present data specific to Miami’s homeless population, including an overview of the primary demographics, causes of homelessness and expressed needs of various racial groups. Several theories regarding factors that may contribute to the racial and ethnic disparities will be presented. Then, presenters will facilitate a discussion regarding the intersection of race, poverty and homelessness in the context of Miami’s history, social systems, and political systems.

Presentation: “Homelessness, mental illness and the criminal justice system: An overview of Miami’s efforts to implement jail diversion programs.”
Judge Steven Leifman (11th Judicial Circuit, Administrative Courts)
Cindy Schwartz, MS, MBA (11th Judicial Circuit, Criminal Mental Health Project)
Manual Sarria, LSCW (Citrus Health Network)
Helena Martinez, PsyD (Citrus Health Network)

Content: A great deal of concern has recently been generated regarding the manner in which the criminal justice system manages the mentally ill. This session shall include an introduction to Miami’s efforts to implement effective jail diversion mechanisms. The first part of the session shall describe how such programs can be developed, highlighting the many issues encountered when working with multiple partners and data systems. The second part of the session shall focus on how one program, Citrus Health Network, established its Crisis Outplacement Bed (COB) program as part of a broader initiative in Miami-Dade County geared at diverting mentally ill individuals away from incarceration and towards community-based treatment programs. The COB program incorporates the provision of supportive housing with a combination of psychiatric and psychosocial assessment and intervention. During the workshop, CHN will describe the structural elements of the COB program and present data on 180 individuals consecutively referred to our program over the past 3 years.

Presentation: “Traumatic Brain Injury and Homelessness”
Stephen Hwang, MD, MPH (University of Toronto)

Content: Clinicians and service providers have occasionally noted that many homeless individuals have a history of traumatic brain injury (TBI), but relatively little research has been done on this subject. This presentation will address the prevalence of TBI in homeless individuals, the temporal relationship between TBI and the onset of homelessness, and the potential role of TBI as a risk factor for homelessness, using data from an ongoing study of a representative sample of 900 homeless people in Toronto, Canada.

Presentation: “Cognitive impairment as a risk factor for chronicity of homelessness”
Jennifer Highley, NP (Common Ground Community)

Content: This presentation will describe efforts undertaken at Common Ground to quantify the deficits in executive functioning found in a chronically street homeless cohort, and discuss how these results can help inform care providers, in order that they can better assist their clients to succeed in the housing process. The session will also cover some of the methods that Common Ground has implemented for assessment of people experiencing homelessness, including factors that the program has learned to look out for, such as history of head trauma and other insults to the Central Nervous System, and will include a discussion about the various neuropsychological assessment instruments they have tried and the rationale for using the RBANS.

Moderator: Ken Kraybill, MSW (National Healthcare for Homeless Council)

Presentation: “Respite care and homelessness: Research, models, and applications.”
Jim O’Connell, MD (Boston Healthcare for Homeless)
Sarah Ciambrone, MS (Boston Healthcare for Homeless)
Suzanne Zerger, MA (National Healthcare for Homeless)
Stefan Kertesz, MD MSc (University of Alabama at Birmingham)

Content: This interactive panel session shall provide an overview and discussion of what we know regarding respite care programs for persons who are homeless. The session shall include a descriptive overview of the types of respite programs operated across the country and presentation of the latest research regarding effectiveness of respite care programs, followed by discussion of how the Boston Health Care for the Homeless program has been able to develop, implement and evaluate its own nationally recognized respite care program. The session shall include discussion regarding best practices, lessons learned, and case studies, with opportunity for audience participation in question and answers.

Presentation: “Involving research in homeless programs: Perspectives from Tampa Bay”
Sondra Fogel, PhD, ASCW  (University of South Florida)
Jack Garrett, MA (Homeless Coalition of Hillsborough County)
Kathy Wiggins, MSW (Hillsborough County School District)

Content: This panel will discuss the ups and downs of incorporating research and evaluation activities into homeless programs, from the practical perspective of those working on the ground in the Tampa-Bay Area. The group will discuss several innovative research projects which are in various stages of implementation, efforts to evaluate programs and HMIS systems, the implementation of the homeless children grant under the McKinney-Vento act, and methodologies being tested for homeless enumeration projects. Discussion shall broach the wide range of issues that emerge when attempting to apply research activities in the real world with operating programs, including data management problems, program fidelity questions, and the delicacy of maintaining productive collaborations between university researchers and providers. This will be an interactive session with lots of opportunity for exchange of ideas regarding how to best incorporate research and evaluation into Florida’s homeless programs.