Expert: ‘Even if shelters were better, they’re still not solving the problem'
Street News Service
Dennis Culhane, Ph.D., hangs up on the Commonwealth of Massachusetts to welcome One Step Away into his office at the University of Pennsylvania. A housing program in Massachusetts had run into trouble with funding and overcrowding, and, of course, it reached out to Culhane, arguably the nation's leading expert and researcher on homelessness.
Culhane's research has contributed to a shift in public policy from a shelter-based system to more emphasis on subsidized housing for people who are chronically homeless. Culhane is the director of research for the National Center on Homelessness Among Veterans at the U.S. Department of Veterans Affairs, and co-directs the Intelligence for Social Policy initiative, a MacArthur-funded project to promote the development of integrated database systems by states and localities for policy analysis and systems reform.
"Our data for much of what we do come from Dennis Culhane," said Mark Johnston, deputy assistant secretary for Special Needs for the U.S. Department of Housing and Urban Development. "I talk to Dennis a lot, and he educates me on something new every time."Culhane began his academic career by living in the shelter system in Philadelphia, and began doing such groundbreaking research here that he never left. Culhane, who had predicted that Massachusetts program would run into trouble, discussed his extraordinary career with One Step Away lead writer Erik Younge and editor Kevin Roberts recently in his Penn office overlooking picturesque Locust Walk. Younge had recently heard Culhane speak publicly that current economic conditions may be creating a new generation of homelessness and asked Culhane about it.
"We discovered several years ago that most of the single adult homeless [people] were born between 1954 and 1967," Culhane said. "That was true in 1988, when the problem first emerged, and it's still true today. When I did my first research project in Philadelphia, I lived in the shelter system for seven weeks. At that time, it was obvious to me that most of the people -- I was born in 1963 -- were my peers. Although there were and are definitely older homeless, the absolutely numerically dominant age was between 25-35 at that time. The average age was 30 years old. Now, the average age is 52. Life expectancy unfortunately, is only 64 for the homeless population. So these folks are moving into what could be the final 10- 15 years of their lives. So their needs are going to change. But from a society perspective, the need for permanent housing solution for these folks is really imperative. Without it, they're going to end up in nursing homes with medical frailty issues that are going to create very high costs. It's just one more way of reinforcing the argument that we need to focus on the chronic homeless problem, because this group is getting older and sicker.
"Taking the long-term view, other factors equal, the chronic homeless population we've known since the 1980s is going to disappear. The big question is: Will they be replaced? What I talked about was -- what was it that led to homelessness occurring in that age group? Why them? They came of age during the double-dip recession in the late '70s and early '80s. They lived with their parents as long as they could. They never got a toehold in the labor market, because the unemployment rate was 30 percent for African-American youth then. The cocaine market and crack market came along and put a lot of these guys to work, but it was hazardous employment where you could get killed or addicted or incarcerated. That's basically the cycle that chronic homelessness has been a part of. They've lived on the margin their whole lives, and it started in their mid- to late-20s. The concern is that we now are in a recession that is very long and yet again unemployment rate is around 30 percent for African-American men. They're not getting into the labor market for an extended period of time, they're living with family and friends at higher rates than ever before ... it's essentially all the same conditions -- except for the crack epidemic -- that made homelessness emerge. So we have to all be vigilant about watching for signs that it's going to happen again.
"We already have data to show that the under-30 homeless population is increasing. And we have to realize that the way that we dealt with this problem in the '80s and '90s did not forestall chronic homelessness, obviously. So, how are we going to help these folks to avoid becoming chronically homeless? That's our new challenge. And I don't think any of us have really focused on that. We've focused on chronic homelessness and how to end chronic homelessness. But we haven't specifically thought about what we do about young adults who are potentially going to be chronically homeless. That's the big question."
One Step Away: You've written before that the data shows the chronic homeless population is finite, and that there's not a wave coming behind the current group.
Culhane: Now there's some concern that that may not be true. The new data is showing increasing under-30 population. It includes veterans. We have a very large number of veterans returning from Iraq and Afghanistan over the next two years. The very real possibility is that there will be a young veteran effect in addition to the economic effects.
One of the things that I've been looking at is if you look at people who do become chronically homeless, you can't predict it in terms of all of their characteristics. But certainly some of the strongest predictors are: Were they on child welfare as a kid, especially as a teenager, and did they have a bout with the juvenile justice system?
Those two factors alone are probably the best predictors of who is going to have the hardest time getting into the labor market and likely be chronically homeless, because they have tenuous family support, and they're less competitive in the labor market. But they're also an easily targeted population. You can't make that up about yourself. It's something that can be a known source of eligibility for programs, and we should be targeting those folks with supportive employment and subsidized employment but really focusing on getting them engaged and working so they don't end up chronically homeless and living on the margins for the rest of their lives. That's what I'm thinking about these days.
Two months in shelter system
One Step Away: Tell us about beginning your career with that stay in the shelter system, where you produced your dissertation On Becoming Homeless (which is available online).
Culhane: I had been a community organizer among homeless people in the 1980s, for an organization that started in Philadelphia called the Union of the Homeless. I was the national director of organizing for the National Union of the Homeless, working in Boston. That involved spending a lot of time in the shelters, as well. I was doing my Ph.D. work at the time, and I thought, 'I have all this incredible access to the viewpoints of people who are experiencing homelessness. Why don't I use that to help inform my dissertation?' I couldn't do an unbiased view of the Boston scene, because I was up there working and organizing. But I had some connections in Philly, so I decided to spend almost two months in the shelter system in Philadelphia. I interviewed people about their experiences and did a lot of observation. I was under cover, so to speak. I did not identify myself as a researcher; I just came in and got in line and got a bed and stayed there.
I had a really unique viewpoint of access to the system that typically an outside researcher would not have because they tend to come through the management structure. But I was an organizer, and I knew the lingo, and the other thing I knew was that the common enemy of homeless people is the homeless shelter. An outsider would not understand that. Shelters are what we're always trying to raise money for to try to get people in. No. Home- less people hate shelters, because shelters give them the stale food and the crowded bed and impose discipline and make them stand in line for this and that, out at 7 in the morning. The people that regulate your life the world sees as your helpers and saviors, but for a homeless person those are the people who are meting out the crumbs of society to you.
Shelters not the solution
One Step Away: Had your previous work prepared you for what you'd find in the shelters? [In addition to the Union of the Homeless, when Culhane was a student at St. Bonaventure University, he'd volunteered at St. Francis Inn]
Culhane: I had known a lot about it. Being an organizer, the most important thing you do is find out about the people you're working with -- what are their most important grievances? The people we worked with, all they talked about was the 'damn shelters.' They felt exploited, they felt manipulated. That's who they saw as the everyday source of their grief, the shelters. I was not surprised, but I was certainly well-equipped to pay attention to how did the rituals of the shelter convey meaning to people about their self-worth, who was in charge, who was in control, who had the power, what was expected.
When I was working with homeless people, I knew I was never going to write a paper concluding that we need more homeless shelters. Even if the shelters were better, which they could always be, they're still not solving the problem. So I was never going to spend my time on that.
One Step Away: Where is the solution?
Culhane: Supported housing is the solution to chronic homelessness; for everybody else we should be working on making sure they don't become chronically homeless ... we should be getting them out [of shelters] as quickly as possible. We just don't have that system in place. We're trying. The federal HPRP (Homelessness Prevention and Rapid Rehousing) program was the first time we paid people to solve these folks' homelessness problem, instead of [saying] here's money to park people in a state of homelessness. A lot of the country got very excited because it changed the way we thought about homelessness.
One Step Away: So how was that shelter stay of yours?
Culhane: Well, shelters have evolved over time, but ... it was pretty rough.
Pushing the envelope
One Step Away: What's kept you in this field, and kept you engaged in continuing to study this area?
Culhane: I was at Boston College, in grad school, focusing on homelessness as my research area. It turned out to be a good topic to focus on, but I certainly didn't expect 20 years later to still be studying it. In the social sciences, people tend to move around on their topics. But the team that I work with, I think we've been successful in pushing the knowledge and informing intervention. I feel very fortunate. I lucked out. But it was that on-the-ground experience, working with the homeless, that gave us the right angle. If you put people in a room to come up with solutions to homelessness, they wouldn't have the right answer, because they'd be coming out of the ivory tower or out of some middle-class experience. I sort of knew all along what direction we were going to go in.
What's kept me going is the success of the research in terms of informing policy and practice. If we hadn't been successful, if it wasn't working, if we weren't getting more resources to the problem and getting solutions, I wouldn't have stayed in it. I'm looking for something that is going to be professionally rewarding for me and for the people I'm working with. We have had a lot of success -- almost 70,000 units of permanent housing between 2005-09 due to the chronic homelessness initiative. That's a lot of people who got off the street and into housing, and that's a good thing. I'm gratified that people say we've pushed the envelope and moved things in a certain direction -- but without the advocates this isn't going to go very far. No one reads these journal articles anyway. The National Alliance to End Homelessness in particular has been very research-oriented, promoting research in important places. Without them, and providers and advocates like them, the research would just sit there.
One Step Away: What's kept you in Philadelphia?
Culhane: I love Philadelphia, quite honestly. It's a great location, convenient to New York and Washington where my work takes me on a pretty regular basis. Quite honestly, Penn has been a great institution for me to be at -- great resources, other collaborators including faculty and grad students. I can't imagine being in a better spot. I never really thought I would go somewhere else.
Philadelphia was one of the places to pilot the concept of Rapid Rehousing before it became a federal program. Philadelphia deserves a lot of credit for that. There's a lot of pioneering activity that's gone on here.
One Step Away: Your career has been about confronting the conventional wisdom. Have there been pieces that you've agreed with, where your work has led you to say, 'Actually, the conventional wisdom has this one right?'
Culhane: Most of interventions people who were in the world of conventional wisdom pioneered an angle. An obvious case would be Sister Mary, who just took common sense around the people who were on the street and would not go into Ridge Avenue [shelter]. She created the safe haven concept. That was her initial contribution. She subsequently got into the supported housing angle and community work as well but the safe haven angle became a national program.
That's a brilliant use of common sense and understanding where people were at, and designing a solution that fit that. The next thing you know she's reducing singlehandedly the number of women on Philadelphia streets dramatically in a short period of time. That's really quite impressive.
And the permanent supportive housing movement was started by people with severe mental illness. These group homes and these residential treatment homes don't work. The whole idea of those things is you go in there and you try to get better, and you graduate to being homeless, because they take away the housing.
What we really need is housing, and then we'll access the services. Don't confuse the housing and the treatment. That was an insight that did not come from the professionals. That was what's called a consumer-oriented idea.
The whole concept of permanent supportive housing came from people with mental illness who said: This system doesn't work. And, by the way, the system they proposed was cheaper and more effective. So it's become the prevailing model, but it didn't come from a bunch of academic professionals sitting around the room. So I think the conventional wisdom -- depending on who's convention you're using -- has been behind a lot of innovations.
One Step Away: As you know, the city is moving toward closing the Ridge Avenue Shelter, Philadelphia's largest men's homeless shelter. That certainly reflects the movement away from shelters and toward supportive housing, which you've supported. Is there a place for shelters anywhere in the system? Is the concept useful at all?
Culhane: There is a place for emergency shelter, but I would say it should be thought of very differently. A bare-bones shelter where people are in by 7 p.m. and out at 7 a.m. and are out on the street all day -- I've never felt that was effective. But yet it is the most common strategy of shelter across the country. Most people think that's OK, because it's better than being on the street. That's what they compare it to. And, in fact, half the single adult homeless in the United States are on the street on any given day. Philadelphia has a relatively rich supply of shelter beds compared to other parts of the country. You go to L.A. or D.C., most of the homeless are unsheltered. Whereas in Philadelphia, we have 400 unsheltered and more than 3,000 in shelters. It's a very different situation in Philadelphia.
To the extent that there is research on shelter -- and there is not a whole lot on it -- the best argument could be made that shelters should be treated as highly programmed interventions that are intended to be time-constrained and that have some targets. Most people leave [a shelter] within 30 days, so we should have a program that's designed to help people when they wake up -- not just when they're asleep. We should be helping them to deal with access to employment, connecting to benefits, helping to resolve conflict with family and friends. We know the No. 1 reason people come into the shelter system is conflict with family and friends. Sometimes it's related to employment problems, sometimes it's related to substance abuse problems, sometimes it's domestic-violence related - and the homeless person can be either the victim or the perpetrator.
The bottom line is that 60 percent of the people coming in report that family conflict is the No. 1 reason they're there. And we also know that 60-70 percent of the people who leave homelessness without any formal housing assistance -- the vast majority of people -- are going back to family and friends.
So it just seems fairly obvious that a shelter should be intended as a time-limited, 30-60 day intervention, not just providing a place to sleep but an intervention designed to help you resolve what's going on in your life that got you here. And that means facilitating your reconnection to family members. They're willing to take them back, but they want to be supported. They want someone who's helping them help this person develop their capacities. If that involves getting into treatment or getting a job or covering some past debts or making good on some issues that have happened, these are all very reasonable.
These are things we should be doing. So I would envision a shelter system that was time-limited but was day-programmed around getting people out. At 30 days, if people are still there then you have to re-assess them and figure out, if you're still here at 30 days, what's really the barrier? The vast majority of your peers have gone, why are you still here? To the extent that we have shelter, we should have a goal of success, within 30 days or, if not, then at 60 days. If people are still homeless at 60 days, there needs to be a whole re-assessment of what's going on here. I'm talking about single adults now, because you asked me about Ridge Avenue.
But I also think there is an opportunity for a couple special populations that you could actually have special shelters that provide the kinds of supports we're talking about. In Chicago, they call this interim housing; they don't call it emergency shelter. Because in an 'emergency shelter,' the idea is that people are going to on their own go out and find services. I just reviewed a study that compared interim housing where the services are provided on site to shelters where they refer people to off-site services. People were eight times more likely to use services [that are offered on-site at the shelter] than people in a shelter who have to go find it on their own.
So if you structure housing deliberately, with the supports there to help people with the intent of moving on, that can work. You have to help people connect with services they need, work with their families, help them get re-housed, instead of [saying] 'Stand in line, come in and get a bed, and then clean up and get out of here and go away until the next night.' I don't know where that's working.
Housing comes first
One Step Away: How difficult is it to analyze a population that is usually dealing with a lot of factors that contribute to their homelessness, such as substance abuse, mental health issues, physical disabilities, sometimes a combination of things?
Culhane: I really like the 'Housing First' phrase, because I think it encapsulates our best knowledge on the issue. It's so hard for people to see past the mental health and substance abuse issues to help people see the housing solution -- especially when you come from a treatment background, as most of the homeless system does, and most of the professionals are treatment professionals. It's a little hard for them to see that what they really have is a person who needs an apartment.
I think the good thing about the Housing First approach is that it really has re-focused us. Look, there are a lot of people in housing who have substance abuse and mental health issues, too. Homeless people have other human needs -- they have to eat, sleep, go to the bathroom, they have relationship issues -- like everybody else.
And, yes, mental health and substance abuse, that may be in there, too. The fact is we need to treat the housing issue as a housing issue, and provide the supports as necessary for people to make it there, including the treatment needs.
But I don't think we should be denying people the housing solution expecting that they have to become clean and sober and saintly before they can get housing. For too many people, that's never going to happen. That's not to say there are not people who benefit from treatment services while they're in emergency shelter. But there are many people, especially the long-term homeless, the chronically homeless, who've been through treatment dozens of times. Some of them have been through treatment hundreds of times.
And it's not succeeding. And we know from the research that only about 60 percent of people do succeed in substance abuse treatment. Are we going to say to the other 40 percent that we're going to consign you to life on the street until you die?
That's how the Housing First movement came along. We've got to have a housing solution for the people for whom we don't have a technology that solves their addiction. We need to solve their homelessness and help them get into a harm-reduction mode and try to get engaged and stabilized, but the housing has to come first. Because they're not going to get [housing] -- the hurdle is too high -- if it's about being sober. That's really helped us, as a field, just the phrase -- to say: 'Aha! We can treat these things separately.'
One Step Away: You've talked a lot about specialized kinds of programs, people who are homeless and in addiction recovery, people who are homeless and ex-offenders. What about veterans?
Culhane: We have a whole initiative with veterans. I work with the VA, and we're similarly bringing a lot of these same ideas, but we're going to be even more aggressive. We're doing a new safe haven in Philadelphia; we're creating a new prevention program we're hoping is going to grow dramatically in size. We're going to do a whole outreach effort to veterans returning from Iraq and Afghanistan to screen them for housing problems, to screen them for extreme poverty and get them connected to prevention assistance before they become homeless. And if they become homeless, we have a rapid re-housing program that we're funding for them. We don't want them coming into a shelter or to create a special shelter. We have the resources to get them back into housing.
Who to pay?
One Step Away: You mentioned that Philadelphia had been a pilot for what is now the HPRP program. How did that change things?
Culhane: HPRP, the great thing about it is it changed the paradigm. The role of the homeless assistance system is not to have a cot for you. The role of the homeless assistance system is to get you out of homelessness. We should pay people ... whose job it is to get you out. Did you solve that person's homelessness? Then you get paid. We don't pay you just to do a housing search, we pay you to do a housing find. If I have a Realtor, the Realtor doesn't get paid to show me apartments. The Realtor gets paid when I move into an apartment. As glaringly obvious as that is, we've never had that in our homelessness system, anyone who got paid to solve the problem. That's just so curious.
One Step Away: Do you work to distance yourself from making personal attachments with the people in your research, or do you want to personally get to know the homeless people you're writing about and working with?
Culhane: Certainly in my earlier work, I was very involved with homeless people. Many of my friends were homeless; I counted among my friends and colleagues people who were experiencing homelessness at that time, and they were influencing my view on the matter. As I've gotten into research with administrative data, I've had much less contact with homeless individuals. When I do go to other cities and visit, one of the things I usually try to ask is whether it's possible for me to go to some programs and actually talk to people. I always like to have homeless people be part of the audience in presentations I make, because I know that that would be a useful part of the conversation. But I haven't had working relationships with people who are homeless in a long time.
One Step Away: Does that influence your work in any way?
Culhane: It would -- it would probably improve it!
KEVIN ROBERTS writes for One Step Away, a street newspaper in Philadelphia.
Photo/Eddie Bird/one Step Away