Houseless versus homeless: an exploratory study of native Hawaiian beach dwellers on Oahu's west coast

This research focuses on the self-perceptions of Hawaii's homeless population, specifically, the homeless beach dwellers on Oahu's west coast, as well as the perceptions of the homeless service providers whose job it is to meet their needs. A review of the literature indicates that homelessness in the United States continues to increase, with the largest group within this population being single parents with children. The current research elaborates on the numerous social policies that have been enacted including judicial polices outlawing such behavior. The literature further clarifies the noted stereotypes associated with the homeless population. What is missing in the research is the perspective or voice of a subgroup of the homeless population on Oahu's west coast. Here, numerous individuals including intact families live in makeshift shelters on the beach that they call home. Part one of this study examined the homelessness epidemic in the United States and reviewed the theories associated with these marginalized populations. Part two of this study explored the experiences and perceptions of this indigenous group of Native Hawaiian homeless living on Oahu to determine who composes this unique subgroup of the larger homeless population. The selected participants participated in in-depth interviews and were asked to share their experiences. Their stories and, more importantly to this study, their voices were heard. Their lives living as houseless families were explored and explained. Their needs were expressed by them and seen through their lenses. Finally, part three of this study explored the perceptions and experiences of the service providers who work with the Native Hawaiian beach dwellers. An in-depth look at the services provided was also conducted. The findings and implications from these various voices are discussed and a direction for future research and social policy creation are presented.

HOUSELESS VERSUS HOMELESS: AN EXPLORATORY STUDY OF NATIVE HAWAIIAN BEACH DWELLERS ON OAHU'S WEST COAST by Martin McDonell A dissertation submitted to the faculty of The University of Utah in partial fulfillment of the requirements for the degree of Doctor of Philosophy College of Social Work The University of Utah December 2014 Copyright © Martin McDonell 2014 All Rights Reserved The Univers i ty of Utah Graduate School STATEMENT OF DISSERTATION APPROVAL The dissertation of Martin McDonell has been approved by the following supervisory committee members: Caren Jean Frost , Chair 04/25/2014 Date Approved Lawrence Henry Liese , Member 04/25/2014 Date Approved Ronald Miller , Member 04/25/2014 Date Approved Rosemarie Hunter , Member 04/25/2014 Date Approved Patrick Thomas Panos , Member 04/24/2014 Date Approved and by Jannah H. Mather , Chair/Dean of the Department/College/School of Social Work and by David B. Kieda, Dean of The Graduate School. ABSTRACT This research focuses on the self-perceptions of Hawaii's homeless population, specifically, the homeless beach dwellers on Oahu's west coast, as well as the perceptions of the homeless service providers whose job it is to meet their needs. A review of the literature indicates that homelessness in the United States continues to increase, with the largest group within this population being single parents with children. The current research elaborates on the numerous social policies that have been enacted including judicial polices outlawing such behavior. The literature further clarifies the noted stereotypes associated with the homeless population. What is missing in the research is the perspective or voice of a subgroup of the homeless population on Oahu's west coast. Here, numerous individuals including intact families live in makeshift shelters on the beach that they call home. Part one of this study examined the homelessness epidemic in the United States and reviewed the theories associated with these marginalized populations. Part two of this study explored the experiences and perceptions of this indigenous group of Native Hawaiian homeless living on Oahu to determine who composes this unique subgroup of the larger homeless population. The selected participants participated in in-depth interviews and were asked to share their experiences. Their stories and, more importantly to this study, their voices were heard. Their lives living as houseless families were explored and explained. Their needs were expressed by them and seen through their iv lenses. Finally, part three of this study explored the perceptions and experiences of the service providers who work with the Native Hawaiian beach dwellers. An in-depth look at the services provided was also conducted. The findings and implications from these various voices are discussed and a direction for future research and social policy creation are presented. TABLE OF CONTENTS ABSTRACT……………………………………………………………………………...iii LIST OF FIGURES ……………………...……………………………………………..viii LIST OF TABLES………………………………………………………………….…….ix ACKNOWLEDGEMENTS………………………………………………………….……x Chapters 1 INTRODUCTION ………………………………………………………………..…….1 Background on the Homeless Problem …………………………………………..1 Literature Review ………………………………………………………………...2 Homeless Identity …………………………………………………….………......3 The Hawaiian Homeless ……………………………………………….…………4 Relevance and Contributions to Social Work ………………………….…………5 Theoretical Perspectives ……………………………………………….…………6 Ecological Theory…………………………………………………………………6 Phenomenological Theory………………………………………………………...8 Resiliency Theory…………………………………………………………………9 Methodology …………………………………………………………….………10 Articles Description ……………………………………………………….…….10 Article #1. The State of Homelessness in the United States …………………….11 Article #2. Voices from the Boat Harbor: A Phenomenological Examination of the Native Hawaiian Homeless Population………………………………………14 Article #3. The Experiences of a Service Provider: A Phenomenological Study on the Experiences of Service Providers Serving the Homeless Community …..16 References ………………………………………………………..……………...19 2 THE EMERGING NEEDS OF HOMELESS POPULATIONS IN THE UNITED STATES: A REVIEW OF THE PROBLEM, PROGRAMS, AND INTERVENTION STRATEGIES ESTABLISHED TO HELP…...…………………………………….22 Introduction ...…………………………………………………….……………...22 Homeless Families Defined…………………………………….………………..25 Demographics…………………………………………………….……………...27 Literature Review………………………………………………….……………..28 vi Structural verses Individual Factors Linked to Homelessness…………………..30 Intervention Strategies…………………………………………………………...39 Emergency Shelter……………………………………………………………….40 Transitional Shelter………………………………………………………………41 Treatment First…………………………………………………………………...43 Housing First……………………………………………………………………..47 Conclusion……………………………………………………………………….50 References………………………………………………………………………. 51 3 VOICES FROM THE BOAT HARBOR: A PHENOMENOLOGICAL EXAMINATION OF THE NATIVE HAWAIIAN HOMELESS POPULATION …61 Introduction……………………………………………….…………………….. 61 The Hawaiian Homeless Population…………………….……………………… 63 Hawaii Literature Review……………………………….……………………… 67 Theoretical Framework………………………………….……………………… 70 Methods…………………………………………………….…………………… 73 Results…………………………………………………………….……………...76 Discussion…………………………………………………………………….… 84 Limitations……………………………………………………………………….86 Conclusion……………………………………………………………………….86 References……………………………………………………….……………… 89 4 SERVING THE HOMELESS: A PHENOMENOLOGICAL STUDY ON SERVICE PROVIDERS' EXPERIENCES WORKING WITH THE HOMELESS POPULATION IN HAWAII…………………………………………………………95 Introduction…………………………………………………..…………………. 95 Health Services…………………………………………………………………101 Methods…………………………………….……………….…………………. 103 Phenomenology Theory………...………………………………………………103 Participants/Recruitment…………………………………….………………….104 Data Analysis………………………………………………….………………. 105 Results………………………………………………………….……………….105 Thematic Findings…………………………………………….………………..106 Service Provided………………………………………………………………..106 Successes and Limitations of Shelters………………………………………….108 Outreach Services………………………………………………………………109 Discussion…………………..…………………………………………………..110 Limitations……………..……………………………………………………….112 Conclusion……………………..……………………………………………….113 References………………………………………………………………………114 5 CONCLUSION…………………………………………………………………….117 Organization………………………………………………...………………….117 vii Chapter 2 Summary…………………………………………………………….118 Chapter 3 Summary…………………………………………………………….118 Chapter 4 Summary…………………………………………………………….119 Social Work Practice Implications…………………………………….….…….120 Social Work Policy Implications……………………………………………….121 Social Work Research Implications…………………………..………..…….…122 Future Research………………………..……………………………………….122 LIST OF FIGURES Figures 2.1 United States Estimates of Sheltered Homelessness 2007-2011..………...………..56 2.2 Hawaii Estimates of Sheltered Homelessness 2007-2011……………….…………57 2.3 United States Estimates of Homelessness by Household Type 2007-2012……...…58 3.1 Estimates of Sheltered Homeless 2007-2011……………………………...……….93 3.2 Oahu Hawaii…………………………………………………..……………………94 3.3 Waianae Coast: The Boat Harbor…………………………………………….…….94 LIST OF TABLES Tables 2.1 Causal Factors Leading to Homelessness……………………...…...………………59 2.2 Intervention Strategies ……………………………………………...……………...60 ACKNOWLEDGEMENTS I thank the many people who assisted me throughout this dissertation process and helped make this dream a reality. My dissertation chair, Dr. Caren Frost, gave me tremendous guidance throughout the process. Her support and mentorship was crucial to my dissertation journey. My entire dissertation committee was instrumental in giving me feedback and encouraging my research pursuits. Dr. Hank Liese gave me incredible support and encouragement throughout my entire experience in the doctoral program. I cannot say enough about Hank and his support. This has been an incredible journey. I need to acknowledge the residents at the Waianae Boat Harbor; thank you for sharing your stories with me. Lastly, I thank my wife Laraine McDonell for encouraging me, supporting me throughout this entire process, and to our 5 kids, Alex, Andrew, Ashley, Alli, and Alyssa; thank you for your patience when I had one more paper to write. I could not have accomplished this without all of you. CHAPTER 1 INTRODUCTION Background on the Homeless Problem Homeless families are now considered the fastest growing segment of the homeless population in the United States (U.S. Conference of Mayors, 2008). There are numerous studies on homelessness; however, the research is somewhat complex due to the wide variety of definitions and causes regarding the homeless, and the difficulty in counting the individuals and families who are homeless. Estimates show that up to 1.35 million children are likely to experience homelessness over the course of a year (National Coalition for Homeless, 2009). Further estimates show approximately 40% of the homeless are homeless families with children (National Alliance to End Homelessness, 2011). It is estimated that between 800,000 to 1.2 million people in the United States are homeless. The U.S. Conference of Mayors (2007) report that 34% of all homeless people are members of families with children (2007). With the rise in homeless families, research has been conducted on the effects on the family dynamics, and on the individual family members including children. The National Coalition for the Homeless (2009) reported that homelessness is a devastating experience for any family. Homelessness damages the physical and emotional health of family members, interferes with children' education and their development including social development, and can result in the separation of family members. 2 Oftentimes families will be separated due to the regulations at shelter homes. These regulations do not allow older boys or men (even husbands or fathers) to reside with women and younger children as an intact family, this resulting in emotional hardships for all involved. Likewise, separations may occur between parents and the children should the children be removed from their parents and placed in foster care as a result of their parents' homeless situation. This separation also has potentially long-lasting effects on the parent/child relationship as any lengthy separation between a parent and a child has the potential to disrupt the bonding process (NCH, 2009). Literature Review Early research in the area of homelessness consisted of ethnographic research done by researchers riding the rails and living amongst the homeless in urban settings (Harper, 1982). Of the urban setting researchers, Wallace (1963) worked with the homeless on Skid Row. Other researchers conducted in-depth research on "street people" and street culture. They found that the homeless experience was "highly related to local context and history" (Miles, 2008). Earlier researchers concluded their studies by identifying that the needs of the homeless get overshadowed by the realities of street life and poverty. Most of the research on homelessness tends to look at the scope and descriptions of the homeless (Miles, 2008). In 1995, Williams studied the homeless in two different cities. Her study compared and contrasted the differences between the "beggar" and the "panhandler." She attempted to distinguish the differences in emotional costs wrought on the two styles of begging (Williams, 1995). Other researchers have examined the life "work" activity of panhandlers. In Homeless: Squeegee Kids: Food Insecurity and Daily Survival, Dachner 3 and Tarasuk (2002) studied the kids who squeegee windows in hopes of obtaining food despite laws that outlaw such behavior. They found that the homeless children were willing to break the law and risk police involvement for the sake of obtaining money through their work. One of the major areas of homelessness research, especially qualitative research, is that of homeless females as individuals or as head of families. The National Law Center on Homelessness and Poverty (NLCHP) published findings on the feminization of poverty and homelessness. This research examined the lived experiences of women who were homeless and presented their perceptions about being homeless (NLCHP, 2004). In another area of qualitative research on homelessness, researchers focused on service delivery. Miles (2008) describes the lack of services for those homeless families seeking to remain in their community. He describes their experiences and perceptions dealing with shelters and their desires to remain as intact families. He found that oftentimes the family would not take advantage of the services available, thus choosing to stay together as an intact family. The current study explored the perceptions of both services providers and Native Hawaiian beach dwellers to see if the services offered in a traditional model of service delivery to homeless individuals was adequate to meet the needs of the beach dwellers. Homeless Identity There is a tremendous amount of social science literature on homelessness in the United States, most of which focuses on the distinctive nature of the homeless (chronically mentally ill and substance abusers) within major populated areas and urban centers. Scholars, researchers, and policy makers have examined aspects of 4 homelessness, lifestyles, behaviors, experiences, and root causes that describe life on city streets (Miles, 2008). This research explored the lived experiences of individuals, who by definition would be considered homeless; however, their perceptions of homelessness and self-identification say otherwise. A newer area of study within qualitative research on homelessness, and one on which this dissertation builds, is that of the identity of the homeless persons themselves. Rosenthal (2000) studied the images of the homeless people and compared their images to the images that the policy makers had of the homeless. He found that the images held by those creating the strategies to end homelessness were different than the images the homeless held. Policy makers actually shaped the strategies and the policies using their own images of the homeless despite being different from the people's view. Furthermore, those creating strategies for program development also had different images and created unique strategies depending on the population (2000). Rosenthal proposed that the individual homeless person was responsible for his/her own perception of the image he/she portrayed. The Hawaiian Homeless In Hawaii, on the island of Oahu, there are an estimated 14,200 homeless individuals who were served statewide during the 2011 fiscal year (Yuan & Stern, 2011). A recent, 2010 "point in time" count of the homeless on a particular night produced 4,171 homeless individuals living on the beaches in the Waianae community on the leeward (west) side of the island. Of those surveyed, 70% identified themselves as Native Hawaiian, and 700 were children under the age of 18 years (Yamane, Oeser, & Omori, 2010). Each of the homeless whether a man, woman, or child has learned to adapt to his 5 or her living situation. Some of the living situations/arrangements include making homes out of tarps, pallets, plywood boards, and abandoned vehicles. These are families who due to a wide variety of circumstances cannot afford conventional housing. Instead, they turn to the beaches and makeshift shelters that they call home. By federal and state definitions, these individuals are homeless. The question is, however, are they homeless or are they just houseless? This unique subgroup of homeless families, as well as the service providers who work with them, are the focus of this dissertation. Relevance and Contributions to Social Work The main impetus for focusing this research on the homeless beach dwellers living on the island of Oahu stems from the definition of homelessness and the associated causal factors regarding homeless people. Memmott (2003) states that one of the problems of categorization is that when applying certain definitions or constructs of "homelessness," the diversity of indigenous groups may be oversimplified, and that at best their needs may be misunderstood and minimally served or at worst overlooked and underserved. Once society defines a group within the population such as the homeless, that definition may limit the individual's growth potential and ability to be self-reliant. This acceptance of the marginalized group is based on society's acceptance of this group as well as the social policies that are created regarding them. The label of "homeless" may also limit the very resources that have been designed to aid those in need due to potentially co-occurring issues. As the homeless population increases, so do the numbers of families who are homeless. One of the key concepts in social work is to view an individual within his or her context within his/her environment. Therefore, to fully understand the needs of each 6 family member who may be without a conventional house, one needs to consider the contextual factors regarding homelessness. This research is relevant to direct social service providers and those who are responsible for program development and evaluation within the homelessness arena in general and specifically for the homeless beach dwellers on Oahu. In addition, social welfare policy makers and the judicial system will benefit from this research as they frequently work within the social welfare system as well as with the homeless population. Given the lack of studies focusing on this indigenous group of Native Hawaiians, the current research can guide community social workers and grant writers who work with this unique group of homeless people. Possibly the largest contribution of this study is to add the voice and perspective of this indigenous group to the body of knowledge regarding Native Hawaiian homeless families. Theoretical Perspectives The theoretical models used to guide this research included Ecological Theory, Phenomenological Theory, and Resiliency Theory. These theories allow for examining the relationship between the homeless individual, those with whom they interact, and the larger community. Further, the theories provide a framework to analyze the interactions and perceptions of the study participants, who could explain their situation rather than having policy or outside experts define it for them. Ecological Theory Ecological Theory states that development is influenced by several environmental systems. Bronfenbrenner (1979) proposed that human development consists of dealing with one's environment. Swick and Williams (2006) explain that Bronfenbrenner's 7 ecological theory is helpful in understanding families because it reflects the dynamic nature of actual family relations (2006). In his work, Ecology of Human Development, Bronfenbrenner (1979) identified five environmental systems that influence one's development. These five interacting systems consist of the following: (a) microsystem, (b) mesosystem, (c) exosystem, (d) macrosystem, and (e) chronosystem. The microstystem refers to the most immediate surroundings or environmental influences of an individual. It is within the microsystem that an individual interacts with peers, family, school, and the neighborhood. It is within the microsystem that individuals live their daily lives and where they develop their sense of identity (Leonard, 2011). The individual is not merely a passive recipient of experiences in these settings, but someone who actually helps to construct the social setting (Bronfenbrenner, 1979). Within the mesosystem, relationships occur between the different microsystems, for example, the relationship between the family and the community or the caring parent and the child. According to Bronfenbrenner (1979), the exosystem seeks to explain the connection between a social setting in which the individual does not have a close, intimate active role and the immediate context of the individual. For example, a child's experiences at home may have an influence on his/her behavior at school. The macrosystem describes in detail the cultural beliefs, values, and political trends as well as the very context where the individual exists. The macrosystem also includes all demographic information, e.g., socioeconomic status, poverty, ethnicity, and religion. Finally, Bronfenbrenner (1979) described the chronosystem as a pattern of environmental events as well as socio-historical circumstances that transition over the life of an individual. It is a combination of all other systems within this theory (Bronfenbrenner, 8 1979). This theory perceives the interactions of each system as dynamic in shaping the individual's perception as he/she experiences society. Ecological Theory describes human development within the context of social influences. Bronfenbrenner's theory supports this study on homeless families on Oahu because it focuses on the individual as well as the development that takes place as the individual interacts with his or her environments: the family, the neighborhood, the community, local government, and society at large. Phenomenological Theory Phenomenological Theory is concerned with the study of one's experience from the individual's perspective. Lester (1999) suggests phenomenological approaches are based in a paradigm of personal knowledge and subjectivity. The theory further emphasizes the importance of personal perspective and interpretation (Lester, 1999). Phenomenological Theory seeks to describe one's lived experiences. This theory will be particularly powerful in the homeless study as individuals will be able to explain their lived experiences and perceptions of their environment, avoiding any preconceived or normative assumptions. To explain this further, Phenomenological Theory is the interpretive study of human experience (Seamon, 1999). The goal is to examine, study, and clarify situations, events, meaning, and experiences as they occur in daily life. As I explored the phenomena of homelessness, I focused on the human experience of the homeless, such as what they see, hear, touch, smell, experience, understand, and/or live through to gain an insight into their daily lives and to see through their lenses how they interpret life. From this description, commonalities were noted and analyzed. For this research to be considered reliable, in-depth interviews with Oahu's 9 homeless beach dwellers were crucial. The in-depth interviews helped to avoid any perceived ideas or thoughts about homeless, thus avoiding any marginalization of this subset group of society. Within the homeless research, there is a weakness or void concerning the homeless individual's perception of actually being homeless. Therefore, this research contributes to the knowledge base and understanding of homeless people. Resiliency Theory Resilience is "a process, capacity or outcome of successful adaptation despite challenges of threatening circumstances" (Masten, Best, & Garmezy, 1990, p. 426). Resiliency Theory research in the social work literature is relatively recent. Fraser, Richmond, and Galinsky (1999) stated: The term resiliency is reserved for unpredictable or markedly successful adaptations to negative life events, trauma, stress, and other forms of risk. If, we can understand what helps some people to function well in the context of high adversity, we may be able to incorporate this knowledge into new practice strategies. (pp. 131-143) Resiliency Theory highlights resources that allow individuals and/or families to succeed despite their perceived or real risks. In their Transactional Framework of Resilience, Kumpfer and Bluth (1999) proposed that the transactional process between parents and children is very important in promoting resilience. They identified six predictors of resilience: (a) the stressors or challenges that cause disequilibrium; (b) the environmental context such as family, school, and community; (c) the interactional process between person and the environment; (d) internal self-characteristics; (e) coping process; and (f) positive outcomes or successful life adaptations (Kumpfer & Bluth, 1999). Analyzing the interviews using the Transactional Framework of Resiliency helped identify risk factors and the predictors of resilience for these families in Hawaii. 10 The research literature on homelessness is thorough in delineating the risks involved with being homeless. However, there is little or no research on the resiliency of families and individuals who are homeless beach dwellers in Hawaii. Utilizing the Transactional Framework of Resiliency allowed this research to examine the lives of the participants and to specifically explore their life successes as they described their daily experiences. Methodology For this study, qualitative research methods were utilized to gain an understanding of the experiences and perceptions of the Native Hawaiian beach dwellers. Qualitative research explores philosophical assumptions, strategies of inquiry, and methods of data collection, analysis, and interpretation (Creswell, 2009). According to Denzin and Lincoln (2011), "the research questions often stress how social experience is created and given meaning. The value-laden nature of such an inquiry stresses the relationship between the researcher and subject(s), as well as the situational constraints that shape the inquiry" (p.17). There has been little research investigating the experiences of the homeless and the meanings they assign to their experiences. This dissertation will allow for an understanding of the experiences of the Native Hawaiian beach dwellers and those service providers who work with them. Articles Description Utilizing the Multiple Article Path (MAP), developed by the University of Utah's College of Social Work, the following section describes the individual articles that are 11 included in this study. Each of the three articles within this research consists of distinct research questions and design. Article #1. The State of Homelessness in the United States The first article is a thorough review of the literature regarding the research done on homelessness in the United States. Homeless polices, definitions, and causal factors were examined. Also, the interventions that are available to the homeless population were explored. Research Question What is the current state of homelessness in the United States? Methods A thorough review was conducted in the literature databases to locate published articles regarding homelessness and intervention strategies. The following databases were used: • CINAHL is the authoritative resource for nursing and allied health professionals, students, educators, and researchers. This database provides indexing for more than 3,000 journals from the fields of nursing and allied health. The database contains more than 2.3 million records dating back to 1981. • ERIC (The Education Resources Information Center) focuses on education literature and resources. ERIC lists citations and abstracts for over 1,000 comprehensively indexed educational and education-related journals, as well as annotated bibliographic records, including journal articles, books, research 12 syntheses, conference papers, technical reports, policy papers, and other education-related materials. • PsycARTICLES: A definitive source of full-text, peer-reviewed scholarly and scientific articles in psychology, the database contains more than 45,000 articles from 57 journals - 46 published by the American Psychological Association (APA) and 11 from allied organizations. It includes all journal articles, letters to the editor, and errata from each journal. • The PsycINFO®, database, American Psychological Association's (APA) renowned resource for abstracts of scholarly journal articles, book chapters, books, and dissertations, is the largest resource devoted to peer-reviewed literature in behavioral science and mental health. It contains over 3 million records and summaries dating as far back as the 1600s with one of the highest DOI matching rates in the publishing industry. Journal coverage, which spans from the 1800s to the present, includes international material selected from approximately 2,500 periodicals in dozens of languages. • Social Services Abstracts allows access to the world's leading scholarly literature in the social sciences, including journals, conferences, symposia, seminars, colloquia, workshops, and conventions. Citation searching enables following the past and future research of a published article. The following terms were utilized in the advanced search feature of each database: family, homelessness, homeless policy, homelessness Hawaii, and homeless children. The following criteria were examined to determine whether the article would be included or not in this research. 13 - Content regarding homeless stereotypes - Demographics of homeless populations in the United States - Social policies regarding homeless and homelessness - Programs established to address homelessness - Homelessness and family dynamics Journal The proposed article will be submitted to Advances in Social Work, a journal committed to enhancing the linkage among social work practice, research, and education. Accordingly, the journal addresses current issues, challenges, and responses facing social work practice and education. The journal invites discussion and development of innovations in social work practice and their implications for social work research and education. Advances in Social Work seeks to publish empirical, conceptual, and theoretical articles that make substantial contributions to the field in all areas of social work, including clinical practice, community organization, social administration, social policy, planning, and program evaluation. The journal provides a forum for scholarly exchange of research findings and ideas that advance knowledge and inform social work practice. All relevant methods of inquiry are welcome. Advances in Social Work is a peer-reviewed journal that publishes original work. Articles are accepted on the basis of appropriateness, clarity, sound methodology, and utility for social work practice, research, and education. Articles are indexed or abstracted in Social Work Abstracts and Social Service Abstracts. Editor: William H. Barton, Ph.D. (journals.iupui.edu/index.php/advancesinsocialwork). 14 Article # 2 Voices from the Boat Harbor: A Phenomenological Examination of the Native Hawaiian Homeless Population The second article focuses on a subgroup of homeless, specifically the Native Hawaiian beach dwellers on the island of Oahu and their unique lifestyle. This article consists of a qualitative examination of the individual lived experiences of the beach dwellers. It explored their needs and perceptions of available resources. Further, it looked at their lives as they describe homelessness. Research Question Overall Question: Are Native Hawaiian homeless beach dwellers a unique group within the homeless population as they are currently defined in the research? RQ1: What is the perception of "being homeless" as seen through the lenses of Native Hawaiian homeless beach dwellers? RQ2: What are the needs of Native Hawaiian homeless beach dwellers and are there adequate resources to meet their needs? RQ3: Does culture have any impact on Native Hawaiian homeless beach dwellers response to being homeless. RQ 4: Do Native Hawaiian homeless beach dwellers share the same causal factors that have been identified in this research as causal factors consistent across homeless populations, or do Native Hawaiian homeless beach dwellers present a unique sub-group of the homeless? RQ 5: Do the intervention strategies that are implemented to assist the general homeless population sufficient to meet the needs of Native Hawaiian homeless beach dwellers? 15 RQ 6: Are there unique cultural practices that the Native Hawaiian homeless beach dwellers subscribe to that set them apart from the rest of the homeless population in the country? Methods Participants were selected using purposive sampling techniques. In-depth personal interviews were conducted using semistructured questions. The interviews were recorded and transcribed line by line. IRB approval was obtained from the University of Utah. A review was conducted in the same literature databases as in Article #1 above to locate published articles regarding homelessness and Native Hawaiians. • Questions were written out and asked to every participant. • All interviews were audiotaped and transcribed. • A journal was kept by the researcher to record observations and impressions. Following the in-depth interviews, all of the interviews were transcribed. The transcriptions were analyzed to identify common and or recurring themes. The themes were then be coded using NVivo software. IRB approval was obtained prior to any interviews that were conducted. Journal The proposed article was prepared for submission to Families in Society: The Journal of Contemporary Social Services. Families in Society: The Journal of Contemporary Social Services is a core publication in social work scholarship and is a trusted forum for social service professionals to explore and share ideas and concepts in the fields of social work and human services. Published by the Alliance for Children and 16 Families, the articles in the journal represent the art and science of social work, and are at the forefront of emerging issues and trends in the field. Those that can benefit from Families in Society are practitioners, clinicians, administrators, researchers, policy analysts, health professionals, educators, and students (www.familiesinsociety.org/currentissue.asp). This journal is relevant to this study as this study explores the lives of Native Hawaiian beach dwellers and their unique life style living in a modern society. Article #3. The Experiences of a Service Provider: A Phenomenological Study on the Experiences of Service Providers Serving the Homeless Community The third article consisted of a qualitative examination of the service providers in Hawaii providing the intervention services to the homeless population. It explored their knowledge regarding the available resources and examined their perceptions regarding the success of their interventions with the homeless families. The research examined the question, are the interventions that are created and implemented for the traditional homeless population adequate to meet the needs of the Native Hawaiian beach dwellers physically as well as culturally? Research Questions RQ 1: What are the perceptions of service providers regarding the homeless Native Hawaiian beach dwellers? RQ 2: What are the perceptions of service providers regarding the success of the intervention programs to reduce or eradicate homelessness? 17 RQ 3: Can homeless Native Hawaiian beach dwellers benefit from the traditional homeless intervention strategies employed on Oahu, Hawaii? Methods This study focuses on the perceptions of homeless service providers and their experiences and knowledge regarding the success of the programs where they work. Interviews were conducted with the service providers using semistructured interviews. IRB approval was obtained through the University of Utah, and providers were recruited through specific homeless service centers on Oahu. All participants were asked to participate in an in-depth interview. Qualitative interviews were conducted until saturation was reached. Standardized open-ended interviews were utilized in order to minimize researcher bias (Rubin & Babbie, 2005). • Questions were written out and asked to every participant. • All interviews were audiotaped and transcribed. • A journal was kept by the researcher to record observations and impressions. Following the in-depth interviews, all of the interviews were transcribed. The transcriptions were analyzed to identify common and or recurring themes. The themes were then be coded using NVivo software. IRB approval was obtained prior to any interviews that were conducted. Journal The proposed article will be submitted to The Journal of Sociology & Social Welfare. The Journal of Sociology & Social Welfare promotes the understanding of social welfare by applying social science knowledge, methodology, and technology to problems 18 of social policy, politics, the social ecology, and social services. The journal provides an outstanding book review section as a regular feature of each issue. Since its first printing in 1974, JSSW has published articles on such topics as social change, gender, race, homelessness, social welfare history, cultural diversity, international social welfare, and the social dimensions of health and mental health (http://www.wmich.edu/hhs/newsletters_journals/jssw/index.htm). This journal is especially relevant to this study as the in-depth interviews with the service providers can have a direct impact on future service delivery and policy creation and analysis. 19 References Advances in Social Work. (2012) Advances in social work. Retrieved from journals.iupui.edu/index.php/advancesinsocialwork Affordable Housing and Homeless Alliance. (2012) Affordable housing and homeless alliance. Retrieved from http://www.hawaiihomeless.org Aguirre, A., & Brooks, J. (2000). City redevelopment policies and the criminalization of homelessness: Narrative case study. Research in Urban Sociology, 6, 75-105. Bronfenbrenner, U. (1979). The ecology of human development: Experiments by nature and design. Cambridge, MA: Harvard University Press. Dachner, N., & Tarasuk, V. (2002). Homeless "squeegeekids": Food insecurity and daily survival. Social Science & Medicine, 54(7), 1039-49. Families in Society: The Journal of Contemporary Social Services. (2012) Journal overview. Retrieved from www.familiesinsociety.org Family Promise of Hawaii. (2012). Who we help. Retrieved from http://familypromisehawaii.org/index.php?option=com_content&view=article&id =174&I temid=215 Fitzpatrick, S. (2005). Explaining homelessness: A critical realist perspective. Housing, Theory and Society, 22(1), 1-17. Fraser, M. W., Richman, J. M., & Galinsky, M. J. (1999). Risk, protection, and resilience: Toward a conceptual framework for social work practice. Social Work Research , 23(3), 131-143. Harper, D. (1982). A good company. Chicago: University of Chicago Press. Kumpfer, K. L., & Bluth, B. (2004). Parent/Child transactional processes predictive of resilience or vulnerability to "substance abuse disorder". Substance Use & Misuse, 39, 671-698. Leonard, J. (2011). Using Bronfenbrenner's Ecological Theory to understand community partnerships: A historical case study of one urban high school. Ruban Education , 46(5), 987-101. Lester, S. (1999). An introduction to phenomenological research. Retrieved from www.sld.demon.co.uk/resmethy.pdf 20 Levin, R., McKean, L., & Raphael, J. (2004). Pathways to and from homelessness: Women & children in Chicago shelters. Retrieved from homeless.samhsa.gov/resource/view.aspx?id=22372* aspxautodetectcookiesupport Masten, A. S., Best, K. M., & Garmezy, N. (1990). Resilience and development: Contributions from the study of children who overcome adversity. Development and Psychopathology2(4), 425-444. Middlemiss, W. (2005). Prevention and intervention: Using resiliency-based multi-setting approaches and a process-orientation. Child and Adolescent Social Work Journal , 22(1), 85-103. Miles, B. (2008). The social construction of deviant behavior in homeless and runaway youth: Implications for practice. Child and Adolescent Social Work Journal , 25 (5), 425-441. National Alliance to End Homelessness. (2011). About homelessness: Snapshot of homelessness. Retrieved from http://endhomelessness.org/section/about_homelessness/ snapshot_of_homelessness National Coalition for the Homeless. (2003). Institute for children and poverty. Retrieved from http://www.nationalhomeless.org/publications/facts/education.pdf National Coalition for the Homeless. (2009). Homeless families with children. Retrieved from http//www.nationalhomeless.org/factsheets/famlies/html National Law Center on Homelessness and Poverty. (2004, January). Increasing homelessness in the United States violates internation law. Retrieved from http://www.nlchp.org/view_release.cfm?PRID=26 Polakow, V., & Guillean, G. (2001). International perspective on homelessness. Westport, CT.: Greenwood Press Inc. Rosenthal, R. (2000). Imaging homelessness and homeless people; visions and strategies within the movement(s). Journal of Social Distress and the Homeless, 9(2), 111- 126. Rubin, A., & Babie, E. R. (2005) Research methods for social work. Pacific Grove, CA.: Thompson/Brooks/Cole. 21 Seamon, D. (2000). A way of seeing people and place: Phenomenology in environment-behavior research. In S. Wapner, J. Demick, T. Yamamoto, & H. Minami (Eds.), Theoretical perspective in environment-behavior (79-88). New York: Plenom Press. Swick, K., & Williams, R. (2006) An analysis of Bronfenbrenner's bio-ecological perspective for early childhood educators: Implications for working with families experiencing stress. Early Childhood Education Journal, 33(5), 371-378. U.S. Conference of Mayors. (2008). A status report on hunger and homelessness in America's cities: A 25-city survey. Retrieved from http://usmayors.org/pressreleases/documents/hungerhomelessnessreport_121208. pdf U.S. Department of Housing and Urban Development. (2008). Homelessness assistance. Retrieved from http://portal.hud.gov/portal/page/portal/HUD/topics/homelessness U.S. Department of Housing and Urban Development Office of Community Planning and Development. The 2010 annual homeless assessment report to congress. 2010. United States Congress 100, 1st session. House. (1987) Steward B. McKinney Homeless Assistance Act: Conference report. Washington, D.C.: U.S. G.P.O. Wallace, S. E. (1965). Skid row as a way of life. Totowa NJ.: Bedminster press. Western Michigan University School of Social Work. (2012) Journal of Sociology and Social Welfare. Retrieved from www.wmich.edu/hhs/newsletters_journals/jssw/index.htm Williams, B. F. (1995). The public I/eye. Current Anthropology , 36(1), 25-51. Yamane, D. P., Oeser, S. G., & Omori, J. (2010). Health disparities in the Native Hawaiian homeless. Hawaii Medical Journal , 69(6), 35-41. Yuan, S., & Stern, I. R. (2011). Homeless Service Utilization Report: Hawaii 2011. Honolulu: University of Hawaii, Center of the Family. CHAPTER 2 THE EMERGING NEEDS OF HOMELESS POPULATIONS IN THE UNITED STATES: A REVIEW OF THE PROBLEM, PROGRAMS, AND INTERVENTION STRATEGIES ESTABLISHED TO HELP Introduction Homelessness is a longstanding social problem in the United States. The emergence of homelessness as a "social problem" dates back to the 1980s. Despite the resources and numerous programs that have been created across the United States, the issue of homelessness continues to grow. Homelessness is no longer isolated to Skid Row, inner city streets, and rail riders (Polakow, 2001). This research explored the current state of homelessness in the United States by identifying the causal factors that contributed to homelessness. The research will seek to find what the current service strategies are and whether these strategies are effective in reducing and ending homelessness. There are numerous studies on homelessness; however, the research is somewhat complex due to the wide variety of definitions, causes regarding the homeless, and the difficulty in counting the individuals and families who are homeless. Estimates show that up to 1.35 million children are likely to experience homelessness over the course of a year (National Coalition for Homeless, 2009). Further estimates show approximately 40% of the homeless are homeless families with children (National 23 Alliance to End Homelessness, 2011). When counting the homeless, there are several categories that are considered (see Figure 2.1). The three main categories are unsheltered, sheltered, and doubled up. People who are unsheltered are people who live on the streets, camp outdoors in parks or open areas, or live in cars or abandoned buildings. Homeless individuals who stay in emergency shelters or transitional housing are referred to as sheltered. Lastly, the third group who typically spends time living temporarily with family or friends are referred to as doubled up (U.S. Interagency Council on the Homeless, 2012). In 1987, the United States Congress passed the McKinney-Vento Homeless Assistance Act. This Act included new language to the definition of homelessness. The new language included "children and youth who are sharing housing of other persons due to loss of housing, economic hardship, or a similar reason; are living in motels, hotels, trailer parks or campgrounds due to a lack of alternative housing accommodations (U.S. Housing and Urban Development, 2008). Still others define homelessness in simple terms such as "men and women with children, who are permanently, temporarily, or periodically without homes; without financial resources; and limited access to health care, housing, or other social services" (Affordable Housing and Homeless Alliance, 2006). In addition, some local agencies define homeless by the national standard, but add criteria of their own when working with specific populations. According to the U.S. Department of Housing and Urban Development (HUD, 2008), a person is homeless whom: lacks a fixed, regular, and adequate night time residence; and has a primary night time residence that is supervised publically or a privately operated shelter designed to provide temporary living accommodations, an institution that provides temporary residence for individuals intended to be institutionalized, or 24 public or private place not designed for, or ordinarily used as a regular sleeping accommodation for human beings. (p. 1) Although there is difficulty in establishing a consistent definition across all disciplines and agencies, the United States federal government, state, and local agencies have defined homelessness and established programs to fight homelessness. For the purpose of this study, the complete definition listed in the McKinney- Vento Homeless Assistance Act as amended by The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009. It states: (1) an individual or family who lacks a fixed, regular, and adequate nighttime residence; (2) an individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground; (3) an individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal, State, or local government programs for low-income individuals or by charitable organizations, congregate shelters, and transitional housing; (4) an individual who resided in a shelter or place not meant for human habitation and who is exiting an institution where he or she temporarily resided; (5) an individual or family who- (A) will imminently lose their housing, including housing they own, rent, or live in without paying rent, are sharing with others, and rooms in hotels or motels not paid for by Federal, State, or local government programs for low-income individuals or by charitable organizations, as evidenced by- (i) a court order resulting from an eviction action that notifies the individual or family that they must leave within 14 days; (ii) the individual or family having a primary nighttime residence that is a room in a hotel or motel and where they lack the resources necessary to reside there for more than 14 days; or (iii) credible evidence indicating that the owner or renter of the housing will not allow the individual or family to stay for more than 14 days, and any oral statement from an individual or family seeking homeless assistance that is found to be credible shall be considered credible evidence for purposes of this clause; (B) has no subsequent residence identified; and (C) lacks the resources or support networks needed to obtain other permanent housing. (HUD, 2013) 25 The federal government takes a different view toward homelessness. The HEARTH Act of 2009 focuses on the sleeping arrangements of a person as the key factor in determining homelessness. Under this Act, individuals are considered homeless if they are sleeping in a shelter, or are part of a program that provides services for homeless individuals, or in a place not meant for human beings (National Coalition for the Homeless, 2003). Some policy analysts claim this definition is too narrow and not a description of the homeless condition. They assert that some people might be able to pay for a room in a hotel for 1 or 2 weeks, but when their money runs out, they are forced to sleep in a park, on the streets, or doubled up with friends and relatives. Therefore, according to the government's definition, individuals living under those circumstances might not be considered homeless despite the fact they lack a permanent residence. Homeless Families Defined One of the fastest growing groups within the homeless population is families with children. It is estimated that between 800,000 and 1.2 million people in the United States are homeless. According to the National Alliance to End Homelessness (NAEH), 40% of all homeless people are members of families with children (2011). With the rise in the numbers of homeless families, research has been conducted on the effects of homelessness on the family dynamics and on the individual family members including children. The NAEH (2011) further reported that homelessness is a devastating experience for any family because it impacts every aspect of the family. There are numerous problems associated with the children of homeless families. These problems include but are not limited to increased mental health issues such as anxiety and depression. They suffer physical ailments as well as stomach problems, poor physical 26 health in general, asthma, ear infections, and speech problems. According to the National Coalition for the Homelessness (NCH) (2009), children are two times more likely to experience hunger and four times more likely to have developmental delays (2009). Further, the NCH (2009) reported that "deep poverty and housing instability are especially harmful during the earliest years of childhood" (2009). Thus, homelessness is a very complex phenomenon that greatly impacts the family. As stated in Al-Haqq (2008), "of the many problems associated with family homelessness, its effects on the family tends to magnify over a short period of time" (2008). He claims that "by the time families request emergency housing they have experienced the loss of their home; separation from extended family members and friends; and changes in their neighborhood environments" (2008). Some of the consequences children in homeless families face are loss of valuable connections with their friends and belongings, and the familiarity of their neighborhood and community (Friedman, 2000). Another consequence for the children as well as the parents is that families will be separated due to the regulations at shelter homes. These regulations often do not allow older boys or men to reside as an intact family, thus resulting in emotional hardships for all involved. Likewise, separations may occur between parents and the children if the children are removed from their parents and placed in foster care as a result of their parents' homeless situation. This separation also has potentially long-lasting effects on the parent/child relationship as any lengthy separation between a parent and a child has the potential to disrupt the bonding process (National Coalition for the Homeless, 2009). Research suggests that family homelessness increased during the recent economic 27 recession in part due to the hardship placed on other family members and friends on whom the homeless families in crisis relied upon. In 2010, 43% of families in shelter became homeless after wearing out their welcome with friends and family. Many of these families were already living at or below the poverty line (U.S. Department of Health and Human Services, 2011). Demographics The U.S. Census Bureau started counting homeless persons in 1990 and continues to include homeless populations in its census counts. Each year, the federal government releases two estimates of family homelessness in the United States: Point-in-Time (PIT) counts and 1-year estimates. The PIT count estimates the number of homeless families both sheltered and unsheltered on a single night in the month of January in a given year. The 1-year estimate describes homeless families in shelters that included both emergency shelters and transitional housing programs during a 12- month period from October 1st through September 30th of the following year. According to the 1-year estimate "the estimated number of people who used an emergency shelter or transitional housing program at any time from October 1, 2010 through September 30, 2011 was 1,502,196 people" (Annual Homeless Assessment Report, 2012, p. 17) (see Figure 2.2). The ratio of homeless individuals from 2010-2011 estimates that 1 in 201 people in the United States were in homeless shelters during that year (Annual Homeless Assessment, 2012). HUD used the PIT counts in its 2012 Annual Homeless Assessment Report (Annual Homeless Assessment) and reported that (a) "633,782 people were homeless in the United States" and (b)"homelessness declined by less that 1 percent" over the past year, and (c) "homelessness has remained stable since January 2011" (p. 3) (Figure 2.3). In 28 addition, the report indicated that in 2012 "homelessness among individuals has declined by 1.4 percent in the past year," but "homelessness among person in families has increased by 1.4 percent" (p. 3). The findings also suggested that "five states account for nearly half of the nation's total homeless population in 2012" and chronically homeless people represent less that 16% of all homeless people (Annual Homeless Assessment, 2012, p. 12). According to the U.S. Conference of Mayors, Annual Hunger and Homelessness Survey: The survey of cities reported that, over the past year, the number of homeless families increased in 60 percent (15) of the cities, decreased in 24 percent (six) of the cities, and stayed the same in16 percent (four) of the cities (Asheville, Boston, Phoenix, and Saint Paul). Across the cities, there was an overall increase of 16 percent in the total number of families experiencing homelessness (2011). This annual collection of data indicated that homeless shelter use was unchanged while the number of homeless families increased. Literature Review Some early research on homelessness consisted of ethnographic research being done by researchers riding the rails and living amongst the homeless in urban settings (Harper, 1982). Of the urban setting researchers, Wallace (1963) conducted research amongst the homeless on Skid Row. Wallace (1963) like other early researchers conducted in-depth research on "street people" and street culture. As Miles noted, earlier researchers found that the homeless experience was "highly related to local context and history" (2008). The early researchers concluded their studies by noting that the needs of the homeless get over shadowed by the realities of street life and poverty. More recent studies on homelessness tend to look at the scope and descriptions of homeless, including their experience with services. 29 Another researcher, Williams (1995) studied the homeless in two different cities. Her study compared and contrasted the differences between the "beggar" and the "panhandler." The author attempted to distinguish the differences in emotional costs wrought on the two styles of begging (Williams, 1995). Other researchers like Drachner and Tarasuk (2002) examined the life "work" activity of panhandlers. In Homeless: Squeegee Kids: Food Insecurity and Daily Survival, the researchers looked at the kids who squeegee windows in hopes of obtaining food despite laws that outlaw such behavior. They found that the homeless children were willing to break the law and risk police involvement for the sake of obtaining money through their work. One of the major areas of homelessness research especially qualitative research is that of homeless females as individuals or as head of families. The National Law Center on Homelessness and Poverty (NLCHP) published research on the feminization of poverty and homelessness. This research examined the lived experiences of women who were homeless and presented their perceptions of being homeless (National Law Center on Homelessness and Poverty, 2004). In another area of qualitative research on homelessness, researchers focused on delivery of services. Miles (2008) described the lack of services for those homeless families seeking to remain in their community. He explained their experiences and perceptions dealing with shelters and their desires to remain as intact families. He found that oftentimes a family would not take advantage of the services available, thus choosing to stay together. Shelters often require breaking up the family unit for the nighttime, since men and women may not stay in the same facility (2008). 30 Structural verses Individual Factors Linked to Homelessness Researchers have examined two categorical explanations of the contributing factors of becoming homeless structural and individual factors (Table 2.1). Structural factors are associate with socioeconomic conditions that affect personal income and the availability of affordable housing, as well as the amount of social welfare benefits a person can access (Lee, 2007). The other category is about individual factors that emphasizes personal attributes to becoming homeless (Lee, 2007). Individual factors or personal factors contributing to homelessness include mental illness, substance abuse, family discord, and domestic violence (Fitzpatrick, 2005). Research on homelessness explains the possible links between socioeconomic factors or structural factors and individuals becoming homeless or being at risk of being homeless. The NCH (2009) reported there "are two socioeconomic factors that are largely responsible for the rise in homelessness over the past 20 to 25 years, a growing shortage of affordable rental housing and a simultaneous increase in poverty" (p. 1). According to Lee (2009), the reduction of social welfare benefits was considered a main contributing factor for many people living in poverty who became homeless. In addition, he states that homelessness is the most devastating consequence of poverty and at the national level, poverty is absolutely responsible for increasing the homeless population. It is important to note that not all people who live at or below the poverty line become homeless. Lee goes on the say that without affordable housing, many people may not be able to find a home that is reasonable for their income. They may share a home with their relatives or friends. Affordable housing shortage is clearly one of the obvious structural conditions that can directly affect low-income people and make homelessness a reality for them 31 (Lee, 2009). Lee also identifies individual factors such as laziness, propensity to wander, and lack of willingness to work as categories as well. Additional characteristics such as mental illness, drug and alcohol abuse, the lack of work ethic, and disease among the homeless population are considered characteristics of the homeless as well as causes of becoming homeless. Having an understanding of the numerous contributing factors of homelessness is necessary in order to develop appropriate and adequate social services and policies to meet the needs of the homeless population (Lee, 2009). A thorough understanding of the potential causes of homelessness will help in the creation of policies and programs. Five of the most significant contributing factors have been identified in the research. They are lack of affordable housing, poverty, mental illness, substance abuse, and domestic violence. Affordable Housing Due to the most recent economic crisis and pared with the federal changes in welfare time limits, more families have found themselves unable to afford suitable housing. These financial strains place families and especially children at risk of inability to cope or function adequately (Levin, McKean, & Raphael, 2004). The US Conference of Mayors (2012), cites the most frequent causal condition related to family homelessness is the demand for affordable housing. As an example in 2011, Amato and MacDonald surveyed 189 homeless men residing in the Pine Street Inn emergency shelter located in New England. The results of their survey showed that lack of affordable housing was one of the biggest factors attribute to homelessness. They claim that "changes in public policy have not solved the problem either as housing prices remain out of reach for a great deal of homeless people" (p. 229). 32 Tent cities have reemerged throughout the United States again in response to the issue of affordable housing and the most recent economic and housing crisis. Loftus- Farren has investigated government and policy responses to the "large gap between the number of homeless individuals and the availability and desirability of homeless shelters in San Francisco California." Loftus-Farren makes the point that housing options have to fit the needs of the population and he argues that tent cities are a viable option even with the concerns of safety and sanitation (2011, p. 1045). He goes on to state that homeless encampments offer only an interim solution as they work on more permanent solution; however, the encampment shows an effort on the part of homeless individual to at least provide a temporary housing solution (Loftus-Ferren, 2011). Poverty Changes in the federal welfare assistance programs have contributed to the increases in poverty, thus resulting in rising numbers of homeless families. Welfare caseloads have declined since the passing of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 due to the eligibility time limits of 2 years consecutively and 5-year lifetime limits (Roschelle, 2008). According to Roschelle, the underlying assumption was that the majority of welfare recipients were long-term, but research shows that it is more cyclical as family and jobs necessitate. This data do not mean the economy is doing better; it means that those receiving financial assistance have been reduced and the potential for inability to afford housing has actually increased. According to the National Alliance to End Homelessness (2011), poverty is one of the key structural factors resulting in homelessness. Poorer people struggle with the demands of sustaining their livelihoods because housing requires a large portion of their 33 income. Individuals are faced with the difficult decisions to pay for food, utilities, clothing, transportation, and many other necessities, and/or housing (National Alliance to End Homelessness, 2011). Amato and McDonald (2011), explain "there are numerous reason for an individual or family to become homeless, poverty is seen by many to be a primary cause" (p. 228). According to Amato and McDonald, in 2008, 13.2% of the United States population or 39.8 million people lived in poverty. The United States Census Bureau reported in the 2010 American Community Survey (ACS) briefs, 46.2 million people or about 15% of the United States population had incomes below their respective poverty thresholds during the year (United States Census Bureau, 2011). From 2009 to 2010, those living below the poverty threshold increased by an estimated 4 million people in just that year alone (United States Census Bureau, 2011). According to the U.S. Department of Housing and Urban Development (HUD), the lack of affordable housing has contributed to the current housing crisis for poor families (National Alliance to End Homeless, 2011). Mental Illness Mental illness is one of the leading individual factors of homeless research. According to the National Coalition for the Homeless (2009), 26% of the homeless population in the United States suffers from a form of mental illness. Society often attributes the high numbers of mentally ill homeless individuals to the release of the mentally ill clients due to de-institutionalization. However, de-institutionalization took place in the 1950-1960s and the large increase in the homeless population who suffer mental illness took place 20 years later in the 1980s. The rise in the homeless population in the 1980s was due to personal economics, low incomes, and increased housing prices 34 (National Coalition for the Homeless, 2009). As reported by the US Department of Health and Human Services, most homeless individuals with mental illness do not need institutionalization and can live in the community with appropriate supportive housing options (National Coalition for the Homeless, 2009). Their research shows that mentally ill individuals are becoming homeless due to their inability to carry out the activities of daily living, like self-care and independent living. Oftentimes the individual with mental illness may have difficulty (a) forming and maintaining relationships, (b) being structured enough for job security, (c) having the inability to care for themselves and/or (d) obtaining adequate shelter. As a result, people with a mental illness are more likely to become homeless than the general population. Homeless individuals with a mental illness are less likely to achieve housing stability without access to treatment and services. The research shows that supportive housing, housing that provides assistance with daily living as well as mental health support, greatly reduces the risk factors involved in the lives of the mentally ill (National Coalition for the Homeless, 2009). According to Balon (2012) in his book review of Homelessness Housing and Mental Illness, Goldfinger, one of the authors and a psychiatrist, is one of the nation's foremost experts on homelessness and mental illness. The book summarized the results of a project that moved 118 homeless people out of shelters in Massachusetts into permanent housing funded by HUD. HUD paid for the first year and half of housing and the Massachusetts Department of Mental Health paid for everything after that. Goldfinger stated that "homelessness and its relationship to mental illness is certainly not just a psychiatric issue; it is also societal, sociological, economical, psychological, and others" (p. 365). The study found that building social ties, not being socially isolated, and 35 identifying needs for sustained living are keys to successful community living and avoiding homelessness. Substance Abuse Another common individual factor associated with homelessness is substance abuse. The literature shows that a large portion of the homeless population is in fact substance abusers. Statistics from the Substance Abuse and Mental Health Services Administration (SAMHSA, 2008) estimate that approximately 52% of the admissions to treatment programs were homeless individuals. SAMHSA suggests that overall 38% of the homeless population were dependent on alcohol and 26% abused other drugs (SAMHSA, 2008). Substance abuse is a factor in both the causes and effects of homelessness. Like mental illness, substance abuse disrupts individual relationships with others, impairs their daily living, and interferes with their employment, all of which can result in being homeless. A 2008 survey conducted by the U.S. Conference of Mayors reported that substance abuse is among the top three causes of homelessness (National Coalition for Homeless, 2009). It should be mentioned that homeless individuals may turn to substance use/abuse as a result of their homeless situation. Further, there are many homeless individuals for whom substance abuse and mental illness co-occur. This co-occurrence presents a unique challenge to the homeless person as many substance abuse treatment facilities will not take a chronically mentally ill client. Likewise, many mental health facilities will not treat a client who suffers from substance abuse. Therefore, treatment options become very limited. According to the National Mental Health Association (2006), "substance abuse treatment on its own is inadequate and needs to be combined 36 with supportive housing opportunities. Supportive housing programs offer services such as mental health treatment, physical health care, education, employment opportunities, peer support, and daily living and money management skills training." There are program options available for homeless individuals with substance abuse issues; however, they may be limited by the very policies established to help the homeless individual overcome their difficulties because many of the policies do not accommodate those who suffer from the co-occurring issues such as mental health and substance abuse. Rhoades, Wenzel, Golinelli, Tucker, Kennedy, Green, and Zhou (2011) conducted a study investigating the risk factors associated with substance use in homeless men in Los Angeles, California. Three hundred homeless men were interviewed about their individual and personal networks, and substance use characteristics. The results showed that the most prevalent substances used were marijuana, crack, and alcohol. The findings indicated that the use of crack was used by those experiencing mental health issues and those with Post Traumatic Stress Disorder (PTSD). Association with family, employment, and school or work showed decreased likelihood to use crack. Rhoades et al. (2008) concluded that homeless men's substance use was associated with riskier personal networks and mental health problems. They emphasized the importance of interventions that focus on improving mental health, mitigating person networks, and maintaining contact with low-risk networks. According to Rhoades et al. (2008) Mental health care and network intervention needs to be a priority to help the homeless. 37 Domestic Violence As the number of homeless families rise, there is an increasing rate of homeless families headed by single mothers. One of the leading causal factors related to homeless families headed by single mothers is domestic violence. The U.S. Interagency Council on Homeless stated "domestic violence creates vulnerability to homelessness for women and children with limited economic resources. Among mothers with children experiencing homelessness, more than 80 percent had previously experienced domestic violence" (2011). Domestic violence often includes financial control, leaving victims with few remaining resources. For women trying to get out of abusive relationships, finding safe, affordable housing is one of the greatest obstacles that they face. Many victims must leave their homes to escape violence but may not have the money to support themselves and their children. Emergency shelters provide a safe, secure, and place to stay. Generally, emergency shelters have a fixed number of days that women can stay, thus leaving the women with two options: return to the abusive situation or become homeless. Many victims end up in precarious and often unsafe housing situations, including living in uninhabitable conditions and/or with friends or families where their abuser might be able to locate them. According to Domestic Violence Counts: On a single day, 67,399 adults and children nationwide sought services after leaving life-threatening abuse. On this same day, domestic violence programs provided emergency shelter and transitional housing to 36,332 adults and children (National Network to End Domestic Violence, 2011). Domestic violence and sexual assault programs are vital to prevent and help end homelessness among families with children, especially in female-headed families. Pavao, Alvarez, Baumrind, Induni, and Kimerling (2007) discussed the findings from the 2003 California Women's Health Survey. The data in the survey were compiled 38 from 3,619 women who suffered from domestic violence. The results indicate that women who suffered from domestic violence were four times more likely to be homeless than those who did not experience abuse. The study also found that domestic violence was associated with housing instability. Fifty percent of participants had at least one housing problem associated with homelessness such as difficulty paying rent, being denied housing, or threatened eviction. Pavao et al. proposed that more research is needed about the possible association with negative health consequences (2007). Roschelle conducted research using data from a 4-year ethnographic study of how the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 impacted women in San Francisco who were homeless and victims of domestic violence. According to Roschelle, "homeless women who are also victims of domestic violence these barriers can become insurmountable" (2000, p. 194). She goes on the state that with the rising rate of family homelessness coupled with the rising rate of domestic violence that welfare reform has been a disaster for "economically disenfranchised women" (2000 p. 194). In addition, women often have barriers to employment and were looked at as being lazy. The barriers include having young children, little to no work experience, physical or mental health problems, children with chronic illness, and less than a high school diploma (Roschelle, 2008). Regarding the individual factors associated with the causes of homelessness, the National Coalition for the Homeless conducted a survey in 2003 of 100 homeless mothers and found that 25% of the women in the study had been physically abused in the past 12 months (National Coalition for the Homeless, 2009). Further, the U.S. Conference of Mayors reported that 50% of 24 cities surveyed identified domestic 39 violence as a primary cause of homelessness (US Conference of Mayors, 2005). The statistics regarding domestic violence and homelessness are alarming. The National Coalition Against Domestic Violence (2001) reported that nationally 50% of all women and children who are experiencing homelessness are homeless due to being victims of domestic violence (2001). Homelessness is extremely hard on individual lives but more so on families. Potentially, it can disrupt the lives of all family members and complicate their daily functioning. Intervention Strategies Across the United States, there are intervention strategies that are utilized to combat and end homelessness. These intervention strategies can be divided into four main categories: emergency shelter, transitional shelter, housing first, and outreach services (see Table 2.2). The literature on intervention strategies combines two specific types of residential shelter care programs, namely, emergency shelter care with transitional shelter together, and refers to this category as the Treatment First Model. Homelessness is a very complex phenomenon, and programs designed to assist individuals experiencing homelessness and reduce homelessness face a number of challenges. One of the more difficult challenges involves engaging and retaining clients who are experiencing homelessness and encouraging them to participate in the supportive services offered (Padgett et al., 2008). The 2009 Annual Homeless Assessment Report (AHAR) documents that on a single night, 643,067 people were homeless. Of those, 63% were sheltered, 37% were unsheltered. Individuals made up 63% and people who presented within family groups were 37%. Over the course of the year, the AHAR reports 1,558,917 people used emergency shelters or transitional housing programs. Most had 40 relatively short lengths of stay in emergency shelters. A small number of people (about one percent) were served in shelters for both families and individuals during the same year (U. S. Interagency Council on Homelessness, 2012). On a single night in 2009, 238,110 people in families were counted as homeless. Most, 79 % were sheltered in emergency shelters or transitional housing. Over the course of 2009, as many as 535,447 people in families were sheltered, an increase of 4 % from the previous year and 13 % since 2007. Only a small group of families used shelters repeatedly (U. S. Interagency Council on Homelessness, 2012). The most common intervention strategies Treatment First Model, Housing First Model, emergency shelter and transitional shelters will be discussed. Emergency Shelter Homeless individuals live in temporary shelters, abandoned buildings, parks, tents, cars, or doubled up with others in unfit apartments. According to the U.S. Conference of Mayors (2012), the total number of emergency beds being used in the 25 participating cities has increased to from 38,499. The report stated that: Twenty-three of the survey cities reported on adjustments which shelters have made to accommodate an increase in demand over the past year. Among these, shelters in 74 percent (17) of the cities consistently have clients sleep on overflow cots, in chairs, in hallways, or in other subpar sleeping arrangements. In 48 percent (11) of the cities, shelters increase the number of persons or families that can sleep in a single room. In 43 percent (10) of the cities, shelters distribute vouchers for hotel or motel stays because shelter beds are not available. Also in 43 percent of the cities, buildings have been converted to temporary shelters. (Conference of Mayor, 2012, p. 27) In addition to the overcrowding, many families and individuals are turned away. According to the report, 60% of individuals and 64% of families with children 41 experiencing homelessness were turned away because no beds were available for them (U.S. Conference of Mayors, 2011). One of the major drawbacks for emergency shelter homes in dealing with homeless families is the separation of sleeping quarters and some shelters exclude men and older boys (Rossi, 1994). However, emergency shelters also provide many services for individuals and families that help to alleviate homelessness or current issues that are being dealt with. Goldstein (2007) reported that many shelters provide access to medical and mental health services, as well as offer opportunities for job training. Some emergency shelters provide temporary housing for female-headed families with the goal of assisting them to find permanent housing in the community in an efficient manner, after having attained stability and the skills necessary to become self-sufficient (Goldstein, 2007). NAEH (2013) reported the average length of stay of individuals accessing shelter care varied by household type and type of shelter program. As NAEH stated, "Single individuals who accessed emergency shelter services alone stayed an average of 120 days" (2013). For families accessing emergency shelter services, the average length of stay was 96 days. The average length of stay is calculated based on unduplicated clients served (National Alliance to End Homelessness, 2013).Within the literature, there is little written on family homelessness and their experiences in the emergency shelter system (Goldstein, 2007). Transitional Shelter The purpose of transitional housing is to provide individuals and families with living conditions that are stable; in addition, a whole family can experience stability 42 while the parents seek permanent housing. Women typically stay longer in transitional shelters than in emergency shelters. To stay in a transitional shelter, women must be motivated to become stably housed, and are expected to participate in programs designed to prepare them for independent living (Goldstein, 2007). One of the biggest issues with families in transitional housing if a loss of privacy: "shelter life means rules, curfews, and exposure to a large number of people. In most shelters, families must sign in and out when entering and leaving" (p. 12). Some shelters require families to attend classes and 12 step meetings. Most shelters have curfews, and regulate visitation hours (Goldstein, 2007). Ryan and Thompson (2012) also conducted research on transitional housing with 29 homeless adults, recruited from two homeless service agencies. The study explored perceptions concerning the issues of using transitional housing programs. Results of qualitative interviews found a variety of issues about why available housing services are not utilized. The issues include distrust of providers, restrictive rules and regulations, unrealistic expectations, excessive requirements for admission, and unsafe living conditions (Ryan & Thompson, 2012). According to Henwood (2011): The most compelling therapeutic justification for the use of transitional housing is that individuals are ill-equipped to live on their own and require a transitional space between homelessness and permanent living in order to (a) achieve an adequate level of stability in terms of mental illness and addiction and (b) learn life-skills such as cooking budgeting, and normative social interactions. (p. 12) The National Alliance to End Homelessness (2013) stated that transitional housing is a housing program for formerly homeless men or women and/or families who have had a successful stay in a homeless shelter or other institutional program prior to application to transitional housing. Residents agree to participate in supportive services to address their individual needs. If substance abuse has been an issue, the transitional 43 housing candidate must be clean and sober for at least 6 months before gaining residence. Residents can stay up to 5 years in transitional housing. Average stay is 18 months (National Alliance to End Homelessness, 2013). Policy analysts argue that transitional housing is an unnecessary step, because they believe that permanent housing should be provided in regular housing that is integrated into all communities, with supportive services available in those neighborhoods. There is very little empirical support regarding the efficacy of transitional housing compared to permanent housing placements directly from shelter (Goldstein, 2007). The National Alliance to End Homelessness (2013) noted concerns about the effectiveness of transitional housing programs. They stated that: Transitional housing is not always used strategically in a community's response to homelessness. Instead, it is a ‘waiting area' for individuals and families who primarily require only housing they can afford to end their homelessness and prevent a reoccurrence. Transitional housing providers, responding to this need, are unable to target their services to individuals and families for whom a residential setting with supports can be most beneficial. (National Alliance to End Homelessness, 2013, p. 1) Although the goal of transitional housing is to provide housing stability while a homeless individual changes his or her behavior related to the risk factors that precipitated his or her trajectory into homelessness, housing is not perceived to provide the total solution to break the cycle of homelessness (United State Interagency Council on Homelessness, 2011). Treatment First Within the homeless services arena there are two distinct service delivery models for adults who are homeless: the Treat First Model and the Housing First Model. The predominant approach that characterizes the majority of homeless services is the 44 Treatment First Model (Henwood, 2011), which positions permanent housing at the end of treatment. Thus, it is only available for those who are successful in transitional shelters. Success in the Treatment First model is defined by treatment compliance, and abstinence from substance abuse. In comparison, the Housing First Model clients start with permanent, independent apartments and providers work with the clients regardless of their symptoms, substance abuse, or whether they participate in formal treatment (Henwood, 2011). Treatment First Model looks at the causal factors and positions treatment as the primary intervention that can lead to stable, permanent housing whereas the Housing First Model, as the name implies, suggests access to permanent housing is the primary intervention to end homelessness (Goldstein, 2007). Within the homeless research, there is overwhelming evidence that supports Housing First as an effective intervention strategy for achieving residential stability and permanency for people who have remained homeless for years. Early evaluations of the Housing First Model in urban areas with primarily chronic homeless individuals have yielded convincing results. Goldstein examined the archival data over a 5-year period and reported 88% of Housing First consumers remained housed as compared to 47% of consumers in traditional residential treatment (2007). Tsemberis et al. conducted randomized clinical trials of housing alternatives and found "individuals assigned to Housing First spent approximately 80% of their time stably housed compared with only 30% for participants assigned to traditional services after two years" (2004). In 2004, under the supervision of the U.S. Interagency Council on the Homeless (USICH) the National Initiative to Help End Chronic Homelessness was funded by 45 national agencies namely, the Department of Housing and Urban Development (HUD), Department of Health and Human Services (HHS), Substance Abuse and Mental Health Services Administration (SAMHSA), and the Veterans Administration (VA). Results from this initiative by the communities involved reported they achieved 85% housing retention rates after 12 months (Mares, Greenberg, & Rosenheck, 2007). The initiative was created by a collaborative effort with a goal of illuminating chronic homelessness. Twenty-four months following the initial implementation of this model, HUD published the outcomes of their 12-month study of the Housing First programs and reported an 84% housing retention rate for the 12-month period (Goldstein, 2007). As stated by Henwood (2011), "although consumers in traditional programs report higher rates of substance use treatment, Housing First consumers who have lower rates of treatment utilization yielded no greater rates of alcohol or substance use in a randomized controlled trial" (p. 5). Treatment First providers typically use an individual case management model working within a residential setting in which the client is expected to uphold program rules in order to transition to the next level of housing (Stanhope, Henwood, & Padgett, 2009). Stanhope et al. go on to state that the Treatment First Model utilizes permanent housing as an outcome and consumers must progress through a series of placements typically starting with drop-in centers or emergency shelters, through transitional housing, and finally into permanent housing (2009). They also explain that should a client relapse, become unstable, or choose not to follow rules necessary for congregate living within the shelter, he or she must leave the program which delays the goal of obtaining permanent housing. In addition, within the Treatment First Model, stability is supported by on-site staff and treatment requirements, along with 46 a therapeutic community environment defined by congregate living with others sharing similar struggles, a model widely used within addiction treatment. Supporters of the Treatment First Model explain that life skills are also learned through social interactions within the shelter home setting as well as through rehabilitation services intended to promote an individual's recovery and daily living skills (U.S. Department of Housing and Urban Development, 2009). The underlying philosophy of the Treatment First approach is that change must occur at the individual level before one can transition into permanent housing. In addition to intense treatment to recover from mental illness and addiction through residential placement, the main motivating factor for an individual to change within "Treatment First" is the promise of permanent housing. This treatment incentive has in its philosophy that an end to homelessness depends on an individual's ability to first learn to manage the conditions or causal factors which led to their current crisis. According to HUD, the Treatment First approach has had limited success at addressing chronic homelessness (U.S. Department of Housing and Urban Development, 2007). This belief that public benefits should in some way be earned by those deemed worthy is deeply embedded within United States social welfare policies and in this case implies that only those who are stable, sober, and compliant are worthy of housing (National Alliance to End Homelessness, 2013). According to the research, with the model of Treatment First, the benefit of stable housing should be earned through successful treatment, and this model implies that clients who are mentally stable and sober should obtain permanent housing. 47 Housing First According to Henwood (2011), "Housing First began out of a need to respond to the unresolved problem of chronic homelessness among individuals with severe mental illness and often with co-occurring addictions" (2011). The model was developed in the early 1990s, as an alternative solution to the Treatment First approach, in which treatment requirements and expectations of client's stability have interfered with ending an individual's experience of homelessness. The model is successful at moving homeless individuals directly from homelessness into independent apartment living through the use of flexible, treatment team-based support services. The program effectively ends chronic homelessness by providing individuals with what they want and need most: an apartment of their own, without requiring up-front treatment and sobriety as proof of "housing readiness" (National Alliance to End Homelessness, 2013). The national Alliance to End Homelessness states that it should be recognized that finding suitable affordable housing is a challenge. It is even harder for individuals and families who lack the skills to search for houses and negotiating with landlords. Housing First providers will typically provide for this for individuals (National Alliance to End Homelessness, 2009). Almost all Housing First programs offer both individuals and families some assistance to pay for housing. This can range from providing access to funds for security deposits and first month's rent, short-term and shallow rent subsidies, and rent subsidies (National Alliance to End Homelessness, 2013). They also state that many Housing First models provide only short-term rental assistance, providing individuals and families with assistance to increase their income through earnings from work and public benefits is a significant part of a Housing First's service plan which 48 encourages self-reliance and personal responsibility. The goal of the Housing First model is to minimize the time people are homeless, including time spent in emergency shelters and/or transitional housing. The primary goal of services is to help the individual or family overcome housing barriers and find appropriate housing. Once the individual or family is moved into their new housing, the goals switch and service goals become the primary focus. These goals focus on the casual factors that led to this individual or family to homelessness (National Alliance to End Homelessness, 2013). Services traditionally provided in "transitional housing" programs are instead provided during a "transitional period of time" after the move to permanent housing (National Alliance to End Homelessness, 2013). Services include substance abuse treatment, mental health counseling, financial counseling, and job readiness skills. In order to be true to a Housing First program, there is no expectation that residency is conditioned on acceptance or compliance with services. The goal is to help individuals and families' access housing that they can remain in as early as possible, minimizing the trauma of homelessness. The National Alliance to End Homelessness (2013) clarifies: On one end of the continuum, permanent supportive housing and other housing models targeted to chronically homeless individuals offer intensive, long-term and specialized services in addition to long-term rental or housing assistance. It is a comparatively expensive but effective intervention and as research has demonstrated, when targeted to the chronically homeless individual it is less expensive than allowing such an individual to remain homeless. On the other end of the continuum, programs are demonstrating that they are able to end homelessness through prevention or rapid re-housing strategies at a smaller cost. (p. 3) The average client's participation within Treatment First programs is much shorter than Housing First programs due to the fact that in Housing First permanent, stable housing is the end result. (Tsemberis, Gucur, & Nakae, 2004). The benefits of Housing First models 49 is that housing is gained quickly, the rate of success is greater, and the long-term cost is less. The Housing First approach is based on the belief that "housing is a basic right and that permanent housing for a homeless individual is the first, rather than the last step in addressing the underlying issues and causes of homelessness for that individual" (George, Krogh, Watson, & Wittner, 2008). In a recent study by the Harm Reduction Coalition, they stated that a Housing First model is best accompanied by a harm reduction philosophy. Under harm reduction, abstinence from drugs and alcohol is not a prerequisite for gaining subsidized housing. "Harm reduction includes practical strategies that intend to reduce the negative consequences of drug use, incorporating a spectrum of strategies from safer use, to managed use to abstinence" (Harm Reduction Coalition, 2006). The Housing First model effectively ends chronic homelessness by providing people with housing of their own, without requiring up-front treatment and sobriety as proof of housing readiness. It is based on a philosophy that housing is a basic human right rather than being reward for successful treatment (National Alliance to End Homelessness, 2013). For people experiencing chronic homelessness, the United States Interagency Council on Homelessness (2010) reports: Housing First models of supportive housing incorporate strategies that minimize barriers to housing access or pre-conditions of housing readiness, sobriety, or engagement in treatment. They assist participants to move into permanent housing quickly and provide the intensive supportive services needed to help residents achieve and maintain housing stability and improvements in their overall condition. These practices seek to "screen in" rather than "screen out" and end homelessness for people with the greatest barriers to housing success. (p. 5) 50 Research suggests that the most successful intervention strategy for ending homelessness is permanent supportive housing that meets the needs of an individual or family. Further, persons who have experienced chronic homelessness frequently have histories of trauma and violence as well as additional barriers to stable housing such as criminal histories, no income, and poor credit. The Housing First model is designed to address these needs (U.S. Interagency Council on Homelessness, 2011). Conclusion In every state and every community, homeless people have complex needs and are influenced by the economic and housing policies of their community. Economically speaking, policy makers have an emerging interest in long-term solutions to homelessness. There are numerous services under the solutions umbrella: emergency shelter, transitional shelter, housing first, and outreach services that are necessary in order to break the cycle of homelessness. The list includes but is not limited to subsidized housing, job training programs, educational outreach programs, financial planning assistance, counseling services, and a range of other supportive services that address the issues that precipitated homelessness. Controversy exists among advocates for the homeless about whether homeless individuals should gain direct access to permanent housing or should first reside in transitional housing. Empirical evidence is needed to resolve this controversy. The goals of housing programs are for residents to: 1) obtain and remain in permanent housing; 2) increase their skills/and or income; and 3) achieve greater self-determination (Miller, 2002). Further research and program evaluations are necessary to gather and analyze data to create more effective service delivery programs and to advocate for social welfare policies that will end homelessness. 51 References Affordable Housing and Homeless Alliance. (2012) Affordable housing and homeless alliance. Retrieved from http://www.hawaiihomeless.org Aguirre, A., & Brooks, J. (2000). City redevelopment policies and the criminalization of homelessness: Narrative case study. Research in Urban Sociology. Al-Haqq, H. J. (2008). How homeless families function: Based on the perceptions of heads-of families. (Unpublished doctoral dissertation). University of Connecticut, Storrs, CT. Amato, F., & MacDonald, J. (2011). Examining risk factors for homeless men. The Journal of Men's Studies, 19(3), 227-235. doi:10.3149/jms.1903.227 Baggerly, J., & Zalaquett, C. (2006). A descriptive study of single adults in homeless shelters: Increasing counselors' knowledge and social action. Journal of Multicultural Counseling and Development, 34(3), 155-163. Balon, R. (2012). Homelessness, housing and mental illness. The Journal of Nervous and Mental Disease, 200(4), 365-366. doi: 10.1097/nmd.0b013e31824cc624 Dachner, N., & Tarasuk, V. (2002). Homeless "squeegeekids": Food insecurity and daily survival. Social Science & Medicine, 54(7), 1039-1049. Fitzpatrick, S. (2005). Explaining homelessness: A critical realist perspective. Housing, Theory and Society, 22(1), 1-17. Friedman, D. H., & Zulfiqar, G. (2009). Massachusetts' system redesign to end homelessness: An overview and assessment. Center for Social Policy Publications. Paper 4. Retrieved from http://scholarwoks.umb.edu/csp_pubs/4 George, C., Chernega, J. N., & Stawiski , S. (2008). Connecting fractured lives to a fragmented system: Chicago housing for health partnership. Equal Opportunities International, 27(2), 161-180. George, C., Krogh, M., Watson, D., & Wittner, J., (2008). Homeless over 50: The graying of Chicago's homeless population. Center for Urban Research and Learning: Publications and Other Works, Paper 21. Goldstein, A. (2007). Homeless families in the New York City shelter system: The long-term stayer. A comparative study of homless families headed by women. Retrieved from ProQuest Digital Dissertations. Handy, E. S. D., & Pukui, M. K. (1993). The Polynesian family sytsem in Ka-‘u, Hawaii. Rutland, VT: Charles E. Tuttle Company, Inc. 52 Henwood, B., Padgett, D., & Nguyen, D. (2011). Consumer and case manager agreement on needs assessments in programs for homeless adults with serious mental illness. Journal of the Society for Social Work and Research, 2(3), 143- 148. doi:10.5243/jsswr.2011.8 Lauber, H., & Mulroy, EA., (2004). A user friendly approach to program evaluation and effective community interventions for families at risk of homelessness. Social Work,49(4), 573-86. Lee, W., (2006). An evaluability assessment of homeless program for families. (Unpublished dissertation). Fuller Theological Seminary, Pasadena CA Levin, R., McKean, L., & Raphael, J. (2004). Pathways to and from homelessness: Women & children in Chicago shelters. Retrieved from homeless.samhsa.gov/resource/view.aspx?id=22372* aspxautodetectcookiesupport Loftus-Ferren, Z. (2011). Tent cities: An interim solution to homelessness and affordable housing shortages in the United States. California Law Review, 99, rev. 1037. Miles, B. (2008). The social construction of deviant behavior in homeless and runaway youth: Implications for practice. Child and Adolescent Social Work Journal , 25(5), 425-441. National Alliance to End Homelessness. (2011). About homelessness: Snapshot of homelessness. Retrieved from http://endhomelessness.org/section/about_homelessness/snapshot_of_homelessness National Alliance to End Homelessness. (2013). The State of Homelessness in America. Retrieved from http://www.endhomelessness.org/library/entry/the-state-of-homelessness National Center on Family Homelessness. (n.d.). Hawaii: American's youngest outcast: State report card on child homelessness. Retrieved from http://www.homelesschildrenamerica.org/pdf/report_cards/short/hi_short.pdf National Coalition for the Homeless. (2003). Institute for children and poverty. Retrieved from http://www.nationalhomeless.org/publications/facts/education.pdf National Coalition for the Homeless. (2009). Homeless families with children. Retrieved from http//www.nationalhomeless.org/factsheets/famlies/html National Law Center on Homelessness and Poverty. (2004, January). Increasing homelessness in the United States violates internation law. Retrieved from http://www.nlchp.org/view_release.cfm?PRID=26 53 National Network to End Domestic Violence. (2012). Domestic Violence Counts. Retrieved from http://nnedv.org/downloads/Census/DVCounts2012/DVCounts12_NatlReport_Co lor.pdf Pavao, J., Alvarez, J., Baumrind, N., Induni, M., & Kimerling, R. (2007). Intimate partner violence and housing instability. American Journal of Preventive Medicine, 32(2), 143-146. doi.10.1016/j.amepre.2006.10.008 Polakow, V., & Guillean, G. (2001). International perspective on homelessness. Westport, CT: Greenwood Press Inc. Rhoades, H., Wenzel, S. L., Golinelli, D., Tucker, J. S., Kennedy, D. P., Green, H. D., & Zhou, A. (2011). The social context of homeless men's substance use. Drug and Alcohol Dependence, 118(2-3), 320-325. Roschelle, A. R. (2008) Welfare indignities: Homeless women, domestic violence, and welfare reform in San Francisco. Gender Issues, 25, 193-209. doi.10.1007/s12147-008906. Rosenthal, R. (2000). Imaging homelessness and homeless people; visions and strategies within the movement(s). Journal of Social Distress and the Homeless, 9(2), 111- 126. Rossi, P. (1994). Troubling families: Family homelessness in Amercia. American Behavioral Sceintist, 37, 342-395. Ryan, T., & Thompson, S. (2012). Perspectives on housing among homeless emerging adults. Evaluation and Program Planning, 36, 107-114. State of Hawaii, Department of Human Service, Homeless Programs Office. (2013). Statewide homeless point-in-time county: 2013 methodology and results. Retrieved from http://humanservices.hawaii.gov/bessd/files/2013/05/2013- Statewide-PIT-Report-5.15.13pdf.pdf Tsemberis, S., & Eisenberg, R. F., (2000). Pathways to housing: Supported housing for street-dwelling homeless individuals with psychiatric disabilities. Psychiatric Services, 51(4), 486-493. doi: 10.1176/appi.ps.51.4.487 Tsemberis, S., Gulcur, L., & Nakai, M. (2004). Housing First, consumer choice, and harm reductions for homeless individuals with a dual diagnosis. American Journal of Public Health, 94(4), 24. United States Census Bureau. (2010). State and country quick facts. Retrieved from http://quickfacts.census.gov/qfd/states/15000.html 54 United States Conference of Mayors. (2008). A status report on hunger and homelessness in America's cities: A 25-city survey. Retrieved from http://usmayors.org/pressreleases/documents/hungerhomelessnessreport_121208.pdf United States Conference of Mayors. (2011). A status report on hunger and homelessness in America's cities: A 25-city survey. Retrieved from http://usmayors.org/pressreleases/uploads/2011-hhreport.pdf United States Conference of Mayors. (2012). A status report on hunger and homelessness in America's cities: A 25-city survey. Retrieved from http://usmayors.org/pressreleases/uploads/2012/1219-report-HH.pdf United States Congress 100, 1st session. House. (1987) Steward B. McKinney Homeless Assistance Act: Conference report. Washington, D.C.: U.S. G.P.O. United States Department of Housing and Urban Development. (2008). Homelessness assistance. Retrieved from http://portal.hud.gov/portal/page/portal/HUD/topics/homelessness United States Department of Housing and Urban Development. (2009). Substance Abuse and Mental Health Services Administration, Annual Report. Retreived from http://homeless.samhsa.gov United States Department of Housing and Urban Development. (2012). Annual Homeless Assessment Report to Congress. Retrieved from www.onecpd.info/resources/documents/2011AHAR_FinalReport.pdf United States Interagency Council on Homelessness. (2010). Supplimental document to the federal strategic plan to preven and end homelessness. Retreived from http://usich.gov/resources/uploads/asset_library/BkgrdPap_Youth.pdf United States Interagency Council on Homelessness. (2012). Searching out solutions: Contructive alternatives to the criminalization of homelessness. Retrieved from http://usich.gov/index.php/issue/alternatives_to_criminalization/ Wallace, S. E. (1965). Skid row as a way of life. Totowa, NJ.: Bedminster press. Watson, T. K. (2010). Restoring out home: Hope, homelessness, and humanity. In The value of Hawaii: Knowing the past, shaping the future. (Homelessness). Retrieved from http://site.ebrary.com/id/10412290?ppg=134 Williams, B. F. (1995). The public I/eye. Current Anthropology , 36(1), 25-51. Yamane, D. P., Oeser, S. G., & Omori, J. (2010). Health disparities in the Native Hawaiian homeless. Hawaii Medical Journal , 69(6), 35-41. 55 Yuan, S., & Stern, I. R., Vo, H., (2012). Homeless Service Utilization Report: Hawaii 2011. Honolulu: University of Hawaii, Center of the Family. 56 Figure 2.1 United States Estimates of Sheltered Homelessness 2007-2011 Data from "Annual Homeless Assessment Report" by U.S. Department of Housing and Urban Development, 2012, p. 17. 1,588,595 1,593,794 1,558,197 1,593,150 1,502,196 1440000 1460000 1480000 1500000 1520000 1540000 1560000 1580000 1600000 1620000 2007 2008 2009 2010 2011 57 Figure 2.2 Hawaii Estimates of Sheltered Homelessness 2007-2011 Data from the "Homeless Service Utilization Report" by Yuan, S., Stern, I. R., & Vo, H., 2012, p. 2. 11,070 12,455 13,177 14,653 14,200 13,980 7,295 8,412 9,422 10,432 9,781 9,650 0 2,000 4,000 6,000 8,000 10,000 12,000 14,000 16,000 2007 2008 2009 2010 2011 2012 Hawaii Oahu 58 Figure 2.3 United States Estimates of Homelessness by Household Type 2007-2012 Data from "Annual Homeless Assessment Report" by U.S. Department of Housing and Urban Development, 2012, p. 3. 671,888 664,414 643,067 649,917 636,017 633,782 423,377 415,202 404,957 407,966 399,836 394,379 248,511 249,212 238,110 241,951 236,181 239,404 0 100000 200000 300000 400000 500000 600000 700000 800000 2007 2008 2009 2010 2011 2012 Estimates of Homelessness by Household Type Total Individual Families 59 Table 2.1 Causal Factors Leading to Homelessness Structural Factors • Lack of Affordable Housing • Poverty • Wage • Cut in Government Programs • Deinstitutionalization Individual Factors • Individual Factors • Substance Abuse • Mental Illness • Physical Disabilities • Lack of Education • Domestic Violence 60 Table 2.2 Intervention Strategies • Emergency Shelters A place for people to live temporarily when they cannot live in their previous residence. • Transitional Shelters A housing program for formerly homeless individual who have had a successful stay in a homeless shelter. • Housing First Model Permanent housing is the primary intervention. • Outreach Services A range of supportive services. CHAPTER 3 VOICES FROM THE BOAT HARBOR: A PHENOMENOLOGICAL EXAMINATION OF THE NATIVE HAWAIIAN HOMELESS POPULATION Introduction Homelessness is a devastating social problem in the United States. There are numerous studies in the social science literature about homelessness, effects of homelessness on individuals and families, as well as exploratory studies on the numerous causal factors relating to and resulting in homelessness. This study examined the Native Hawaiian beach dwellers living on Oahu in the state of Hawaii to see if Native Hawaiian homeless beach dwellers are a unique group within the homeless population. The following research questions were explored: Do Native Hawaiian homeless beach dwellers present a unique subgroup of the homeless? Are the intervention strategies that are implemented to assist the homeless population sufficient to meet the needs of the Native Hawaiian homeless population? Are there unique cultural practices that the Native Hawaiian homeless beach dwellers subscribe to that sets them apart from the rest of the homeless population in the country? In 1987, the United States Congress passed the McKinney-Vento Homeless Assistance Act that defined homelessness. This Act included the definition of homelessness and was used as the definition throughout government programs relating to 62 homelessness (U.S. Department of Housing and Urban Development, 2008). The definition listed in the McKinney-Vento Homeless Assistance Act was amended in The Homeless Emergency Assistance and Rapid Transition to Housing (HEARTH) Act of 2009. A portion of this revised definition relates specifically to this study states that a homeless person is: (1) an individual or family who lacks a fixed, regular, and adequate nighttime residence; (2) an individual or family with a primary nighttime residence that is a public or private place not designed for or ordinarily used as a regular sleeping accommodation for human beings, including a car, park, abandoned building, bus or train station, airport, or camping ground; and (3) an individual or family living in a supervised publicly or privately operated shelter designated to provide temporary living arrangements including hotels and motels paid for by Federal, State, or local government programs for low-income individuals or by charitable organizations, congregate shelters, and transitional housing. (Department of Housing and Urban Development, 2012). The HEARTH Act of 2009 definition focuses on the sleeping arrangements of a person as the key factor in determining whether one is homelessness. This HEARTH Act (2009) is important for this research because it examined specifically whether some people will define themselves as homeless even when their sleeping arrangements comply with the definition. Homeless families are now considered the fastest growing segment of the homeless population in the United States (U.S. Conference of Mayors, 2008). The National Alliance to End Homelessness (NAEH) (2011) reported that homelessness is a devastating experience for any family. Homelessness disrupts every system within the family. The research suggests mental health issues such as anxiety and depression are associated with children from homeless families. Many children suffer physical ailments as well such as stomach problems, poor physical health in general, asthma, ear infections, 63 and speech problems (NAEH, 2011). The National Coalition for the Homeless (NCH), reported that children are 2 times more likely to experience hunger and 4 times more likely to have developmental delays (2009). Further, the NCH (2009) reported that "poverty and housing instability are especially harmful during the earliest years of childhood" (2009). As a result, homelessness is a very complex phenomenon that greatly impacts all aspects of the family. Despite the efforts at the federal, state, and local levels homelessness continues to increase. The Hawaiian Homeless Population Hawaii's statistics and demographics are unique due to the indigenous Native Hawaiian population. Although social service programs are utilized by residents of the islands, these services have not been as effective for the Native Hawaiian population. A brief history of the homeless population in Hawaii and some demographic information will fill out the unique issues in delivery of housing options, resources, and services for this group. Current and longitudinal information is available about the effectiveness of programs for the homeless population in Hawaii, but the literature about and research on is sparser. According to American's Youngest Outcast: State Report Card on Child Homelessness, "Hawaii ranked 3rd in the nation in child homelessness" (National Center on Family Homelessness, n.d, p. 1). This ranking is determined based on structural factors such as the lack of affordable housing and employment opportunities. In the data collected by the McKinney-Vento Educational Program, over 1,500 children in Hawaii experience homelessness each year. The report stated that the cost of housing is so much above the amount earned by two adults receiving minimum wage that decent housing is 64 not attainable in most places in Hawaii. With this type of instability, even a minor financial crisis can propel a family into homelessness. The situation in Hawaii warrants further investigation about the effectiveness of homeless programs and funds being used to support interventions and supportive programs. For the past 7 years, the Center on the Family at the University of Hawaii and the Homeless Programs Office of the Hawaii State Department of Human Service has compiled demographic and quantitative information about the homeless population in Hawaii (see Figure 3.1). The information is published in the Homeless Service Utilization report each year to track data about the homeless population. As noted in the report, the information is completely from the state's Homeless Management Information System (HMIS), an electronic data system that all service providers who receive state and federal funds are required to use. A few other agencies participate on a voluntary basis as well. The 2012 report summarized information from the state of Hawaii and for each county presented demographic information regarding age, residency, ethnicity, and type of household. Demographic data are also compiled about individual utilization of services provided by outreach programs, and emergency and transitional shelter programs. The report summarized the number of people using services and programs: From July 1, 2011 to June 30, 2012, the Shelter and Outreach Programs served a total of 13,980 individuals statewide. This number represents an unduplicated count of persons who experienced homelessness and received shelter and/or outreach services during the 2012 fiscal year. (Yuan, Stern, & Vo, 2012, p. 4) The two largest ethnic groups utilizing services were Native Hawaiians and Caucasians. Caucasians represented 32% of services used and Native Hawaiian represent 28% of services used. Each ethnic group is over-represented compared to the general percentage of the population in those two ethnic groups: Caucasians 26.1% and Native 65 Hawaiian 10.1% (Native Hawaiian and Pacific Islanders alone) (United States Census Bureau, 2013; Yuan, Stern, & Vo, 2012). The reports stated that individuals who have used serviced for the first time was 43% statewide. The report also noted that the past 2 consecutive years have seen a slight decrease in the use of programs down by a total of 5%. The year 2010 was the peak year of services used with an all-time high of 14,653 clients. In shelter programs, 34% were children 18 years and younger. In addition, 71% of adults were unemployed and about 70% had a high school diploma or less. For over half of the people in families, this experience was their first time accessing sheltered care. Homelessness in Hawaii is a very complex issue. To understand homelessness in Hawaii, it is necessary to have a brief overview of Hawaiian history and the Native- Hawaiian culture. The Blount report supplies some important historic information on the relationship of Hawaii and the United States in regard to commercial and military endeavors. The United State president, Grover Cleveland, sent Commissioner James H. Blount to Hawaii to investigate the overthrow of the Kingdom of Hawaii. President Cleveland also wanted to know how the people of Hawaii felt toward new authority. On January 17, 1893, the Kingdom of Hawaii under the rule of Queen Liliuokalani was overthrow by the United States government. The United States Minister to Hawaii ordered the landing of American Marines in support of a committee of 13 businessmen who sought to seize political power. Fearful of the American military, Queen Liliuokalani ceded her authority, not to the committee, but to the United States (U.S. Public Law, 1993). In 1897, a protest petition against annexation to the United States was sent to Washington D.C. Over 21,000 Native Hawaiians, representing the overwhelming majority of adult Hawaiians, had signed the anti-annexation petitions (Silva, 1998, p. 61). 66 Queen Liliuokalani appealed to the United States government, but never recovered her throne. The transfer of 1,800,000 acres of Hawaiian Government lands or nearly half the Hawaiian Islands was given to the United States. In 1898, with opposition, Hawaii was annexed to and became a territory of the United States. Two years later, Sanford Dole, former President of the Republic of Hawaii, was appointed as the first governor. After the annexation, plantations were expanded by commercial endeavors and the ancient land management systems was fading away with the lines blurred between business and government. Pearl Harbor was attacked on December 7, 1941, propelling the United States into World War II. The Hawaiian Islands became a strategic military base. In March of 1959, Hawaii became the 50th state. Many Native Hawaiians are resentful of the illegal land acquisition and the change of traditional land rights and ownership. In addition, many Native Hawaiians believe that the land still belongs to them today and the ancient way of living off the land is endemic to who they are and the life style that they enjoyed. Tricia Kehaulani Watson a Native Hawaiian from Manoa writes: "We must all embrace traditional Hawaiian values, especially in respect to the family. Hawaiian concepts of stewardships were not simply about the land. They were about the family, because the land is our family" (Watson, 2010, p. 131). For early Hawaiians, there was no private ownership of land; however, they did have a complex system of land division. According to Handy and Pukui (1993), each island was divided into pie shaped sections called "ahupua'a" running from the mountain to the ocean. The division of land was a way to provide self-sustaining units from agriculture to building materials to fishing resources. Taxes were paid to one person who oversaw the resources and operation of the land and also supported the chief and his 67 needs. In ancient and traditional Native Hawaiian culture, the family ("ohana") is the fundamental or functioning unit, which is people related by blood, marriage, or adoption. The values of the culture reflect this unit and a connection is made between the land ("aina") and the family as a source of physical and spiritual support (Handy & Pukui, 1993). The land physically and spiritually supports the family; the land supports the family as a connection of respect for their ancestors. This reciprocal relationship between the land and the family is vital in understanding Native Hawaiians today in being able to foster necessary and effective supportive resources the land is seen as providing physical support and shelter. These concepts are crucial when considering service delivery for homeless Native Hawaiians. Hawaii Literature Review Research specific to homelessness in Hawaii is sparser with even less research on the indigenous Native Hawaiian population. Boyce, Tice, Ona, Akinaka, and Lusk (2009) studied the prevalence of hepatitis among homeless people in Hawaii. They found that homeless people in Hawaii were more likely to have hepatitis B and C because of the commonness of drug use, tattoos, sexual contact, and sharing of personal hygiene items. Boyce et al. (2009) suggested that homeless shelters would be a good place for education, screening, and intervention. Barnes, Barnes, Small, Otto, and Bennett (2010) researched the ocular health of Oahu's homeless population. The study included a cross-sectional sample of 127 participants. Barnes et al. (2010) concluded that "the homeless population of Oahu has a high dissatisfaction with vision" compared to a national sample. Poor knowledge of eye care services was also noted. They suggested that mobile eye screening units would be ideal for providing ocular healthcare to the homeless population. 68 Another study examined the barriers to healthcare of homeless people using shelter care in Hawaii (Hoshide, Manog, Noh, & Omori, 2011). Hoshide et al. (2011) noted that homeless people in Hawaii have one of the highest health insurance coverage in the nation with 77% of homeless adults having some form of health insurance compared to that national average of 45%; however, there are still considerable unmet healthcare needs. They also noted that Hawaii is fourth in the nation for the most Homeless residents per capita. The study included 128 participants from three shelters and used a cross-sectional survey of self-reported demographic questions and 29 Likert scale questions. The study found that the most common health problems were decompensated, psychiatric illness, trauma, substance abuse, and infections (p. 214). This research also found that homeless people were "five times more likely to be admitted to acute care hospitals compared with the general public" and "100 times more likely to be admitted to the state psychiatric hospital" (2011, p. 214). Hoshide et al. noted that homeless was likely a causal factor for these admissions and stated that there was a significant deficiency in accessing healthcare despite the prevalence of homeless people