2011

C o u n t i n g M a t t er s:
Baltimore City Homeless Point-In-Time Census Report Morgan State University School of Architecture + Planning

City of Baltimore

Project Team + Acknowledgements

Project Leaders: Susan Olubi, M ary Anne Alaban za Akers, Ph.D. School of Architecture a nd Planning M organ State University Team Members: Mayors Office of Human Services Homeless Services Program Kate B riddell Sean Hall Gabby Knighton Morgan State University M arvin Perry, Office of Sponsored Programs Jonathan VanGeest, Ph.D. School of Community Health and Policy & Center for Health Linda Loubert, Ph.D. Department of Econonmics Hands inPartnership Abdallah Ibrahim Kibibi M atthews Baltimore City Fire Department Capt. C harline B. Stokes Baltimore City Police Department Lt.Col. Garnell Green Sgt. Carla Hamlin Data Analyst and Report Writer: M ary Anne Alaban za Akers, Ph.D. Jonathan VanGeest, Ph.D. Editor: Hanni Rochelle Werner Graphic designers: Joey Stevens Godwin Obami
2

We would like to acknowledge the following individuals a nd organizations for their contribution to the project: Thomasina Hiers Gloria Townsend Mayors Office of Human Services Jamila Keita Mayors Office of Human Services Dennis Murphy Our Daily, Bread Kirk Mitchell Downtown Partnership of Baltimore The Hands-in Partnership (HIP) Outreach Teams We are espe cially grateful to ALL the volunteers who walked the streets of Balti more and visited the homeless drop-in centers on Ja nury 25, 2011.

Note: The views and opinions expressed in this report do not

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

Table of Contents
5 6 I. Executive Summary II. Introduction Unsheltered Count Method Sheltered Count III. Homeless Census Results Over-all Census Counts Increase in Unsheltered Count IV. Characteristics of the Homeless A. Household Composition B. Age C. Gender D. Race V. Homelessness in the City of Baltimore A. Households with Children B. Veterans C. Chronically Homeless VI. Health Conditions of the Homeless Population VII. Sleeping Places of the Unsheltered Homeless VIII. Conclusion

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13

17 21 24

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

List of tables and figures

Table 1 Table 2 Table 3 Table 4 Table 5 Table 6 Table 7 Table 8 Table 9 Table 10 Table 11 Census Counts of Sheltered and Unsheltered Homeless Individuals Comparison of Unsheltered Population, 2009 and 2011 Percent Increase of Unsheltered Population, 2005 to 2011 Distribution of Families with Children Age Distribution of Sheltered and Unsheltered Population Gender of the Homeless Age Distribution of Veterans Reported Health Concerns of Sheltered Homeless Individuals Frequency of Respondents Receiving Treatment for their Health Concerns Health Conditions of Unsheltered Population Percentage of Unsheltered Homeless Having or are Receiving Treatment for their Health Conditions

Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Figure 7 Figure 8 Figure 9

Baltimores Homelessness Trends Change in Sheltered and Unsheltered Homeless Population, 2009 and 2011 Household Composition of Sheltered Homeless Population Age and the Sheltered Homeless Race and the Homeless Change in Sheltered Households with Children (HMIS 2009, 2011) Change in Homeless Veteran Population (HMIS & Survey, 2009, 2011) Percentage of Chronically Homeless Among Sheltered and Unsheltered Populations Places that Unsheltered Respondents Slept In

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

Executive Sum mary

To comply with the US Department of Housing and Urban Developments mandate, the Baltimore Mayors Office of Human Services Homeless Services Program, Morgan State University School of Architecture and Planning, Hands in Partnership, and Baltimore Fire Department conducted a point-in-time census count of homeless individuals in Baltimore City on January 25, 2011. The night count (from 1:00 to 6:00 a.m.) and day count (7:00 am to 3:00 p.m.) took place to estimate the number of unsheltered homeless persons. Together with the street counts, volunteers conducted surveys among those willing to participate. Baltimores Homeless Management Information System (HMIS) data base was also used to track the number of people who stayed in homeless shelters during the early morning hours of the census date. Summarized below are the results of the study: 1. Baltimores homelessness situation is on an upward trend. In eight years, the homeless population swelled from 2,681 in 2005 to 4,088 in 2011, an increase of 1,407 individuals. Particularly concerning is the change from the last census years. The rate of homelessness inc reased from 13.9% (2007 to 2009) to 19.6% (2009 to 2011). 2. The HMIS system recorded 1,772 individuals who checked into homeless shelters on the census date in 2011. Of this population, 17.6% or 311 individuals were children and 83% were adults. A significant percentage of these children (76.9%) were ten years old and younger. 3. There has been a slight increase of the number of veterans since 2009. An increase of 26 sheltered and 6 unsheltered veter ans were counted in 2011. 4. The three top healt h conce rns that impac t the homeless population in the City of Baltimore are substance abuse, mental healt h, and chronic health.

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

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Introd uction
Homelessness is a concern that affects many urban communities in America today and a social and public health priority. Nationally, it is estimated that at least 800,000 people are homeless on any given day in the United States, including approximately 200,000 children.1 To track our countrys homelessness problem, the U.S. Department of Housing and Urban Development has mandated cities that receive funding from the Continuum of Care program under the McKinneyVento Homeless Assistance Act must undertake biennial Point-In-Time (PIT) counts of their homeless population. The City of Baltimore conducted its Point-In-Time census on January 25, 2011. The PIT consisted of two parts: the unsheltered and sheltered counts. Unsheltered Count Method The methods used for the biennial unsheltered count involved night and day counts. 2 A. Night Unsheltered Count: From 1:00 a.m. to 6:00 a.m., more than 100 volunteers conducted the night count. Equipped with surveys, maps, and count sheets, twenty five teams of volunteers drove and walked through their assigned neighborhood to count and, when possible, to speak with unsheltered homeless individuals. The volunteers also targeted local hospitals, a common place of refuge for homeless individuals. The following neighborhoods were covered in the 2011 Biennial census unsheltered night count. 3

Downtown/M ercy H ospital M ount Vernon/M aryland G eneral Penn-Fallsway/Oldtown Jonestown/Pleasant View Gardens Dunbar Broadway/ M iddle East/ Johns Hopkins Wolfe Street Patterson Park M idtown/Belvedere Charles N orth/ Charles Village Greenmount West/ Greenmount Cemetery Oa kenshawe/ Waverly/ B etter Waverly/ Good Samaritan M odawmin/ Towanda-Grantley/ Sinai H ospital Canton/Hopkins B ayview Fells Point Little I taly/In ner Ha rbor Stadium a rea/Camden I ndustrial Area Federal Hill Riverside/Port Covington Brooklyn/ Ha rbor H ospital/ St. Agnes H ospital University of M aryland Seton Hill/ Heritage C rossing Poppl eton/ Hollins M arket/ Franklin Square/ Union Square/ Bon Sec ours H ospital Druid H eights/Upton

Burt, M., Aron L.Y., Lee, E., & Valente, J. (2001). Helping Americas Homeless: Emergency Shelter or Affordable Housing? Washington, DC: The Urban Institute Press. 2 As defined by the US Department of Housing and Urban Development, an unsheltered homeless person resides in a place not meant for human habitation, such as cars, parks, sidewalks, abandoned buildings, or on the street. 3 The neighborhoods were selected based on reported presence of homeless individuals.
1

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Map of selected neighborhoods for the unsheltered night count

To determine if the homeless clients receiving services from these agencies had been unsheltered during the hours of 1:00 a.m. to 6:00 a.m. that morning, volunteers asked them three questions: Did you stay in a homeless shelter last night (evening of January 24th and early morning 25th)? Did you sleep in a place last night other than a homeless shelter (evening of January 24th and early morning 25th)? Have you already been interviewed by someone from our census project? If an individual responded no to all three questions, he or she was counted as unsheltered and invited to participate in the census survey. To help determine the number of unsheltered homeless that day, administrators of various drop-in centers provided an estimate of the percentage of unsheltered homeless among the clients they serve. Volunteers from the census project then applied this percentage to the number of clients served on January 25th. Sheltered Count Method: The biennial sheltered count involved two methods. One used the Homeless Management Information System (HMIS) and the other was based on the information provided by homeless service providers.

B. Day Unsheltered Count: From 7:00 a.m. to 3:00 p.m., volunteers and Homeless Services Program staff conducted the second part of the unsheltered count. They visited homeless service centers, including places that provide meals for the homeless. Appendix A lists the service programs that provided information for the unsheltered day count.

tion System is the Homeless Management Information System (HMIS) that Baltimore City uses to track clients who stay in emergency shelters, overnight shelters, and transitional housing. The PIT census used information provided by this comprehensive information system to register and track the number of sheltered homeless individuals. Appendix B lists the service agencies included in the HMIS data base.
7

A. HMIS Sheltered Count: The Regional Online Services Informa-

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

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B. Non-HMIS count: Homeless service providers who do not participate in the HMIS database were able to provide the number of individuals who stayed at their facilities on the census date. These individuals were included in the sheltered count. Appendix C lists the service organizations who reported their data to the Homeless Services Porgram.

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

Homeless Counts

II I
A. Over-all Census counts
Data source Street count (night) Service centers (day) HMIS data system Total

Homeless Census Results

The results of the biennial census indicate that there were 4,088 homeless individuals in Baltimore City on January 25, 2011. As seen in Table 1 below, almost half (43.9%) of this homeless population were unsheltered that night. Compared to the results of the 2009 census which counted 3,419 homeless people in Baltimore, the 2011 census noted a 19.7% increase in the homeless population. This change is quite significant considering that in comparison, the national homelessness rate increased by 3% last year.
FIGURE 1 BALTIMORES HOMELESSNESS TREND

TABLE 1 CENSUS COUNTS OF SHELTERED AND UNSHELTERED HOMELESS INDIVIDUALS

Sheltered Unsheltered 140

4500 4000 3500 3000 2500 2000 1500 1000 500 0

4088 2943 3001 3419

2681

2003

2005

2007

2009

2011

1,655 1,772
521

B. Increase in unsheltered count: The increase noted in Baltimores homeless population is mostly attributed to a change in the unsheltered population. As indicated in Figure 2 and Table 2, compared to the last census period, the 2011 census indicated a 45.5% increase in the unsheltered group. Although the project catchment area was expanded for the 2011 street count, the growing number of unsheltered people who sought services from various meal programs also contributed to this considerable change.

Non-HMIS reports from service providers

2,293

1,795

4,088

As seen in Figure 1, homelessness in Baltimore is on the rise. Between 2003 and 2011, Baltimores homeless population increased over 50%, from 2,681 to 4,088, respectively. Particularly concerning is the change between the most recent census years. The rate of homelessness increased by 13.9% from 2007-2009 and by 19.6% from 2009-2011.

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

Homeless Counts

III
4500 4000 3500 3000 2500 2000 1500 1000 500 0 Unsheltered Sheltered

FIGURE 2 CHANGE IN SHELTERED AND UNSHELTERED HOMELESS POPULATION, 2009 AND 2011

55.5% increase. ( Table 3)

TABLE 3 PERCENT INCREASE OF UNSHELTERED POPULATION, 2005 TO 2011

2005 2007 2009 2011

Unsheltered % Count Increase 82 629 667.1% 1154 83.5% 1795 55.5%

2009 1154 2265

2011 1795 2293

C. Sheltered Count Results Compared to previous years, the 2011 census only recorded a minimal increase (1.5%) in the sheltered population. Only one traditional transitional shelter, Helping Up John Hopkins Program/Spiritual Recovery program, was established since the last census count. IV. Characteristics of the Homeless

TABLE 2 COMPARISON OF UNSHELTERED POPULATION, 2009 AND 2011

A. Household Composition: More than half (56%) of sheltered homeless individuals in the 2011 census were single adults. Of this group, 77.1% were men, and 22.8% were women. Comparatively, the US Department of Housing and Urban Development reported that in the national homeless population, 65.3% of those who seek residential assistance are male. 4

Night count (street count) Day count (clients in homeless services) Total unsheltered count

2009 89 1,154 1,243

2011 140 1,655 1,795

Compared to Marylands overall statistics on homelessness, the increased number of unsheltered homeless individuals in Baltimore City is quite significant. According to a report by the National Alliance to End Homelessness, Maryland noted a 34% increase in its unsheltered population from 2008 to 2009, compared to Baltimore Citys
Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

U.S. Department of Housing and Urban Development. Annual Report Assessment to the U.S. Congress. February 2007.

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IV
Families with children 44%
Female w/Children Male w/Children Couple w/Children

Characteristics of Homeless
Families with children made up close to half (44%) of the sheltered homeless population (Figure 3). Of the 468 families, a large percentage (86.3%) was single mothers and their children. And of these single female households, a little more than half (52.2%) included children under the age of eleven. The census also noted other types of family households, such as couples with children (10.7%) and single fathers with children (3.0%), who slept in shelters on January 25, 2011. (Table 4)
FIGURE 3 HOUSEHOLD COMPOSITION OF SHELTERED HOMELESS POPULATION

B. Age: The HMIS database recoded 1,772 individuals who checked into homeless shelters on the census date. Of this sheltered population, 80% were adults, 2% and 17% were young adults and children, respectively (Figure 4). A significant percentage of the children (81.4%) were ten years old or younger. The statistics regarding homeless children are important since these children tend to exhibit more health problems than poor children who have homes. 5 Homeless children are also at a higher risk for having poor nutrition and developing infectious diseases, asthma, and lead poisoning. The percentage of sheltered homeless youth in Baltimore City (17%) is below the national average. According to the National Law Center on Homelessness and Poverty, 39% of the national homeless population is under eighteen.6 Their report also states that 42% of these children are below the age of five. In the Baltimore census, 51.6% of children in shelters were five years old or younger.

Other .3%

Single households 56%

FIGURE 4 AGE AND THE SHELTERED HOMELESS

60 years and older 5% 17 years and younger 18% 18-21 years old 2% 22-59 years old 75%

TABLE 4 DISTRIBUTION OF FAMILIES WITH CHILDREN 404 14 50 468

6

86.3% 3.0% 10.7%

5

Total Families

Family Housing Fund. Homelessness and its effect on children. Minneapolis, Minnesota. December 1999. National Coalition for the Homeless. Who is Homeless? Fact sheet, July 2009

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Sheltered Number 17 and younger 18-21 years old 22-30 years old 31-40 years old 41-50 years old 51-60 years old 61 and older Total 311 42 183 231 474 438 92 1771

Table 5 below shows that more than half of the adult homeless population were 41 years old and older. Among the sheltered and unsheltered groups, 59.4% and 74% are 41 years and older, respectively. Of concern is the number of older adults who are homeless. During the census date, 122 seniors were found in shelters and 17 older individuals were sleeping outside during a cold winter night.

C. G ender Men were still the predominant group in the homeless population. Table 6 shows that at least 65% of homeless individuals, both sheltered and unsheltered, were males. Only one respondent indicated he was transgender.
TABLE 6 GENDER OF THE HOMELESS Sheltered Number Male Female Transgender Total 208 109 1 318 % 65.4% 34.3% 0.3% 1772 Unsheltered Number 1173 599 % 66.2% 33.8%

As indicated below in Table 5, more than half of the adult homeless population in this census were over forty years old. Among the sheltered and unsheltered groups, 56.7% and 74% were over forty years old, respectively. The number of older adults who are homeless is particularly concerning. On the census date, volunteers found 122 seniors in shelters and 17 older individuals sleeping outside on a cold winter night.
TABLE 5 AGE DISTRIBUTION OF SHELTERED AND UNSHELTERED POPULATION Unsheltered % 17.6 2.4 10.3 13.0 26.8 24.7 5.2 Number 2 6 27 46 117 96 17 311 % 0.6 1.9 8.7 14.8 37.6 30.9 5.5

D. Race: Nationally, African Americans disproportionately represent the homeless population. Although they make up only 12% of the countrys general population, they represent 40% of the homeless population.7 Similarly, African Americans make up a significant percentage of the homeless group in Baltimore. As shown in Figure 5, 80% of the sheltered homeless and 85% of the unsheltered homeless are African American. Considering that the U.S. census estimates the Black population in Baltimore to be 63.7% of the total city population, they represent a larger share of the homeless population.
7

Note: Several respondents did not provide their age information.

Sparks, Elizabeth. 2006. African American and Mental Health in Encyclopedia of Mental Health Psycology

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

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Caucasian 16% Other

Homelessness in Baltimore City

FIGURE 7 RACE AND THE HOMELESS
4%
Caucasian 12% Other 3%

4) After population reductions from 2005 to 2008, the number of chronically homeless people in the country remained stagnant from 2008 to 2009, despite an 11 percent increase in the number of permanent supportive housing units. 5) While most people experiencing homelessness are sheltered, nearly 4 in 10 were living on the street, in a car, or in another place not intended for human habitation. 8 A. Households with children: Unlike other cities across the country, the number of sheltered households with children in Baltimore decreased (Figure 7). In 2009 there were 548 homeless households with children compared to 468 in 2011. There are two possible explanations for this decline. A number of homeless shelters closed in the past two years, perhaps contributing to the loss of numbers. Furthermore, it is possible that some homeless families have doubled up 9 with families or friends who have homes. According to the National Alliance for Ending Homelessness (NAEH), between 2008 and 2009, the number of families who double up grew by 12%. The NAEH also reports that families who seek shelter with other families have a one in ten chance of eventually becoming homeless again. These families will likely end up in homeless shelters.

African American 80%

African American 85%

Sheltered Homeless

Unsheltered Homeless

V. Homelessness in Baltimore City The Alliance to End Homelessness states that the nation is experiencing an increase in the number of homeless people. The findings of a publication, State of Homelessness in America 2011, include this summary: 1) The nations homeless population increased by approximately 20,000 people from 2008 to 2009 (3 percent increase). There were also increased numbers of people experiencing homelessness in each of the subpopulations examined in this report: families, individuals, chronic, unsheltered. 2) A majority 31 of 50 states and the District of Columbia - had increases in their homeless counts. 3) Among subpopulations, the largest percentage increase was in the number of family households, which increased by over 3,200 households (4 percent increase). Also, the number of persons in families increased by more than 6,000 people (3 percent increase).

National Alliance to End Homelessness. State of Homelessness in America 2011. January 11, 2011, p.2. Available at: http://www.endhomelessness.org/content/article/detail/3668. 9 National Alliance to End Homelessness. State of Homelessness in America 2011. January 11, 2011, p.2. Available at:

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

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2 468 1 548 0 500

987 Single Households Households with children 1106

Veterans make up 23% of the homeless population. Veterans make up 33% of the male homeless population. 47% of homeless veterans served during the Vietnam War era. 67% of homeless veterans served three or more years in the army. 79% of homeless veterans reside in central cities.11 76% of homeless veterans experience alcohol, drug, or mental health problems. 46% of homeless veterans are white males, compared to 34% of homeless non-veterans. While only 20% of general homeless population are at least forty five years old, 46% of homeless veterans are over the age of forty four.12

1000

1500

B. Veterans Veterans as a group have been particularly vulnerable to homelessness. They are a primary concern for the US Department of Veterans Affairs, who, in 2009, served more than 92,000 veterans through specialized homeless programs.10 Many veterans are experiencing the impact of a poor economy with a lack of income and access to health care. Many are also dealing with post-traumatic stress disorder (PTSD) and substance abuse problems. The National Coalition for Homeless Veterans offers the following statistics on homeless veterans: Veterans make up 23% of the homeless population. Veterans make up 33% of the male homeless population. 47% of homeless veterans served during the Vietnam War era. 67% of homeless veterans served three or more years in the army.

On the night of the PIT census, 313 veterans accounted for 17.7% of the sheltered homeless. Of these, 247 were over forty years old and 29 were over sixty years old.
TABLE 6 AGE DISTRIBUTION OF SHELTERED VETERANS 21 to 30 years old 31 to 40 years old 41 to 50 years old 51 to 60 years old 61 years or older Total 13 24 90 157 29 313 4.2% 7.7% 28.8% 50.2% 9.3%

10

National Coalition for Homeless Veterans. Facts and Media. Available at: http://www.nchv.org/background.cfm#facts Central cities are heavily populated cities at the core of large metropolitan areas. Ibid.
14

11 12

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26 2011 20 2009

Of the unsheltered homeless counted in this 2011 census, 26 (8.1%) were veterans. Most of them were over forty years old. The data collected during the census indicates that since 2009, there has been a slight increase in the number of homeless veterans. Figure 7 shows that there were twenty six more sheltered veterans and six more unsheltered veterans in 2011.

of homelessness in the past three years.13 However, in 2010 the HUD department expanded this definition to include families with children. These characteristics are often found among the chronically homeless: They are typically male and middle aged. About 80% are male and 60% are between thirty five and forty years old. They usually live on the streets or in other places not meant for human habitation. 63% are considered unsheltered. They have multiple physical or mental disabilities. They frequently visit emergency rooms, metal health services centers, and treatment centers for substance abuse and detoxification. Often they seek out criminal justice resources. 14 During the 2011 census in Baltimore City, volunteers noted 196 sheltered individuals who were chronically homeless, about 11% of the entire population counted that night. Of the unsheltered population, 256 (89.8%) were chronically homeless. The average age of the sheltered chronically homeless was forty seven, and the average age among the unsheltered chronically homeless was forty six.

FIGURE 7 CHANGE IN HOMELESS VETERAN POPULATION (HMIS & SURVEY, 2009, 2011)

Unsheltered

Sheltered

313

287

C. Chronically homeless The US Department of Housing and Urban Development defines a chronically homeless person as an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more, or has had at least hour episodes
Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

13 14

U.S. Department of Housing and Urban Development. http://www.hud.gov/offices/cpd/homeless/chronic.cfm National Alliance to End Homelessness. Chronic Homelessness: Policy Solutions. March 2010.

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Homeless less than a year 10%

FIGURE 8 PERCENTAGE OF CHRONICALLY HOMELESS AMONG SHELTERED AND UNSHELTERED POPULATIONS

Chronically homeless 17%

Sheltered

Homeless less than a year 83%

Unsheltered

Chronically Homeless 90%

Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

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Health Conditions of the Homeless Population

Poor health and homelessness are closely related. People who lack permanent shelter are exposed to extreme climates, infectious diseases, unsanitary conditions, violence and other health threats. Often, they experience rates of serious illnesses and injuries that are three to six times higher than other people.15 Available comparisons suggest that the homeless in Baltimore experience these conditions in similar proportions to national homeless populations. For example, the prevalence rate of HIV (the virus that causes AIDS) is comparable to national estimates (3.7% vs. 3.4%). Overall, rates of HIV among the homeless are at least three times higher compared to the general popu19 lation, with a HIV rate of 1%. While not reported here, studies have identified even higher HIV prevalence rates (8.5% 62%) in various homeless subpopulations, including adults with severe mental illness.20 Domestic violence was also experienced by approximately 3% of those interviewed. This is important, as domestic violence has been identified as a risk factor for homelessness among women and families. 21

The three top health concerns that impact the homeless population in the City of Baltimore are substance abuse, mental health, and chronic disease (Table 7). With regards to substance abuse, rates are very similar to national estimates. Although difficult to assess, the Substance Abuse and Mental Health Services Administration (SAMHSA) estimates that approximately 38% of homeless people are dependent on alcohol and 26% abuse other drugs.16 Substance abuse, in particular, is an important indicator for understanding homelessness, as it has been identified as both a significant cause and consequence of loss of domicile. For instance, in a 2008 survey by the United States Conference of Mayors, cities identified substance abuse as the single largest cause of homelessness for single adults (reported by 68% of cities).17 12% of cities also mentioned substance abuse as one of the top three causes of homelessness among families. As could be expected, mental health generally is also a concern among the homeless in Baltimore, with 20.1% of the sheltered home18 less population interviewed reporting a mental health condition (Table 7). This is slightly lower than national estimates, which identify 39% as reporting a mental health problem. Like addiction, mental illness which is frequently co-occurring can lead to and prolong homelessness. Other health-related conditions were evident among the sheltered homeless in Baltimore, including HIV/AIDS (3.7%), chronic health issues (10.4%), and physical disability (3.9%) (Table 7). Available comparisons suggest that the homeless in Baltimore experience these conditions in similar proportions to national homeless populations.
15

National Healthcare for the Homeless Council. Homelessness and Health: Whats the Connection. January 2010. http://www.nhchc.org/Hln_health_factsheet_Jan10.pdf Substance Abuse and Mental Health Services Administration. Homelessness Provision of Mental Health and United States Conference of Mayors. Hunger and Homelessness Survey: A Status Report on Hunger and See footnote 15. Allen DM et al. HIV infection among homeless adults and runaway youth, United States, Zolopa AR, Hahn JA, Gorter R, et al. HIV and tuberculosis infection in San Franciscos

Available at:
16

17

Substance Abuse Services. SAMSHA, 2003.

Homelessness in America's Cities. 2008. Available at: http://www.usmayors.org/uscm/home.asp

18 19

1989 - 1992. AIDS 1994;8: 1593- 1598.

20

homeless adults: Prevalence and risk factors in a representative sample. Journal of the American Medical Association 1994; 272: 455 - 461.
21

National Coalition for the Homeless. Domestic Violence and Homelessness. NCH Fact Sheet #7. Washington,

D.C.; National Coalition for the Homeless, 2007;

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Substance abuse Mental health HIV/AIDS Chronic health diseases Physical disability Domestic violence Communicable disease MR/DD or ADD Chronic mentally ill Learning Disability Ex-Offender Unspecified disability

TABLE 7 REPORTED HEALTH CONCERNS OF SHELTERED HOMELESS INDIVIDUALS Frequency 618 369 191 67 71 54 3 4 4 6 2 1 Percentage 33.7% 20.1% 10.4% 3.7% 3.9% 2.9% 0.2% 0.2% 0.2% 0.3% 0.1% 0.1%

in this population.22 Unmet treatment needs are not simply a result of a lack of available services in the city. The condition of homelessness itself also presents serious barriers to treatment, as those experiencing loss of domicile are impoverished and often uninsured, lack transportation, and have difficulty understanding or adhering to treatment regimens.
TABLE 8 FREQUENCY OF RESPONDENTS RECEIVING TREATMENT FOR THEIR HEALTH CONCERNS % receiving Frequency Substance abuse Mental health Chronic health HIV/AIDS 599 341 193 51 13.5% 13.5% 16.1% 3.9% treatment

Despite the high prevalence of a number of health conditions, relatively few of the sheltered homeless interviewed in Baltimore reported receiving treatment (Table 8). Unmet treatment needs are most apparent with regard to substance abuse and mental health services. Significant discrepancies also exist in behavioral health services for chronic health conditions. This too is consistent with studies identifying significant unmet health and mental health care needs
Counting Matters: Baltimore Homeless Point-In-Time Census Report (2011)

The health conditions reported by unsheltered homeless are extensive and range from weather-related health conditions (e.g., frostbite, hypothermia, heat stroke) to chronic health conditions such as asthma and diabetes (Table 9). As can be expected, weather-related exposure conditions were frequent in this population, with 37% reporting a history of frostbite and other cold-weather related conditions, and another 27% experiencing heat-related exposures.

22

Baggett, T.P., OConnell J.J., Singer D.E., Rigotti N.A. The Unmet health care needs of homeless adults: A national study. American Journal of Public Health. 2010; 100(7):1326 - 33.

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Chronic diseases are also common, with significant percentages of those interviewed reporting asthma (43%), hepatitis (43%), diabetes (28%), cardiovascular diseases (27%), liver disease (25%), and kidney disease (19%). Finally, the unsheltered homeless in Baltimore reported health conditions indicative of a history of accidents or violence, with over 50 % reporting a physical disability and 39% reporting a serious brain injury or head trauma.

TABLE 9 HEALTH CONDITIONS OF UNSHELTERED POPULATION Frequency Physical disability that limits your mobility (requiring a wheelchair, having an amputation, etc) Asthma Hepatitis C Serious brain injury or head trauma that required hospitalization History of frostbite, Hypothermia, or Immersion Foot Diabetes History of Heat Stroke/Heat Exhaustion Heart Disease, Arrhythmia, or Irregular Heartbeat Liver Disease, Cirrhosis, End -Stage Liver Disease, or Jaundice Kidney disease, End -Stage Renal Disease, or Dialysis Cancer HIV+ / AIDS Tuberculosis or TB Emphysema Pregnant
23

54 43 43 39 37 28 27 27 25 19 9 8 7 2 2

As noted, the health conditions reported by the unsheltered homeless in Baltimore are consistent with studies identifying disparate risk of morbidity and mortality among the homeless compared to the general population. This risk is linked to chronic conditions such as cardiovascular disease, HIV/AIDS, and diabetes compared to the general population. 23 24 25 26

Breakey W.R., Fischer P.J., Kramer M., Nestadt G., et al. Health and mental health problems of homeless men Frencher S.K. Jr., Benedicto C.M., Kendig T.D., Herman D., et al. A comparative analysis of serious injury and Hwang S.W., Orav E.J., OConnell J.J., Lebow J.M., et al. Causes of death in homeless adults in Boston. Ann - 28. Kerker B.D., Bainbridge J., Kennedy J., Bennani Y., et al. A population - based assessment of the health of

and women in Baltimore. J Am Med Assoc. 1989; 262:1352 - 7.

24

illne ss among homeless and housed low income residents of New York City. J Trauma. 2010;69: S191
25

Intern Med. 1997;126: 625

26

homeless families in New York City, 2001- 2003. Am J Public Health. 2011;101: 546 - 53.

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Like their sheltered counterparts, the unsheltered homeless in Baltimore report significant unmet treatment needs . Among the areas with the greatest need for treatment are exposure-related conditions (frostbite, heat stroke, etc), chronic diseases (liver disease, hepatitis C,etc.), serious brain injuries, cancer, and physical disabilities. This is, again, consistent with studies identifying significant unmet health and mental health care needs in this population. These unmet treatment needs affect health services delivery in the city, as the unsheltered homeless usually seek care through local emergency departments. This situation results in significant costs and lack of necessary services.

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Environmental Assessment of Sleeping Places of the Unsheltered Homeless

In addition to the demographic, health, and economic aspects of the homeless population, the 2011 Biennial census also studied the places where the unsheltered homeless remained overnight. In this census, the School of Architecture and Planning at Morgan State University included an important but often neglected component of homeless livingthe spatial factors associated with homeless life. This is a particularly important subject because it highlights the conflict between the homeless and those who wish to control public spaces. Local government regulations often criminalize this impoverished group. However, to solve the homelessness problem, local governments and policy makers must appreciate the relationship between urban spaces and homeless visibility. To provide insight into the behavior patterns of the homeless and their use of urban spaces, this section of the census report examines the places where unsheltered homeless individuals slept during the early morning of January 25th. Volunteers used two methods to gather data on the spatial dimension of homelessness. First, they surveyed the unsheltered individuals, examining their choice of location. They also assessed 140 sites where homeless individuals were spotted from 1:00 a.m. to 6:00 a.m. that morning. To examine a spatial phenomenon such as homelessness required a clear understanding of the psychological role of physical space. The surveys used in this census addressed the environmental components of physical space and how the need for controlling personal territoriality can help someone achieve psychological wellbeing. In the survey, volunteers asked the unsheltered respondents about where they seek out shelter. Based on a list of places provided, they asked the respondents, In the past thirty days, have you slept in any of the following locations? Volunteers concluded that the unsheltered individuals mainly sought out shelter in one of three places: emergency shelters, outdoors, and in the homes of family or friends Figure 9.
FIGURE 9 PLACES THAT UNSHELTERED RESPONDENTS SLEPT IN

3 Home rented by you via public housing/ sec on 8 4 Group home 8 Transi onal Housing 9 Home rented by you 12 Psychiatric Treatment facility 14 Substance Abuse Treatment Facility 17 Jail/Prison 18 31 Car/Van 45 Subway/bus 60 Hospital 75 Vacant/Abandoned building
Home owned by you Family/Friend's home Outdoors Emergency Shelter 0 20 40 60

103 157 165

80 100 120 140 160 180

Volunteers also assessed over one hundred sites where homeless individuals had sought refuge. The following pictures depict some of the various places where the unsheltered homeless slept during the early morning hours on the census date.

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Downtown neighborhood:

Environmental Assessment of Sleeping Places of the Unsheltered Homeless

Canton neighborhood Similar to the downtown sites, the space outside a church building was a sleeping place for a homeless person. Homeless individuals were spotted sleeping in two downtown spots identified in the map below. The research team observed that the sites were found in recessed spaces outside of buildings. Homeless individuals usually pick places like these because of the privacy and weather protection they provide.

Dunbar Neighborhood The spot below showed where a homeless person was found. The brick siding may have provided some heat to this individual.

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Patterson Park Neighborhood Seton Hill Neighborhood

Environmental Assessment of Sleeping Places of the Unsheltered Homeless

Pleasant View Gardens One of the sites in Pleasant View Gardens was behind a retaining wall. A homeless person slept close to the bushes for privacy and protection. A homeless person slept close to a public telephone. The team found that machines provide a source of heat because they operate 24 hours everyday.

Camden Yards Underpasses are known to be favorite sleeping places for the homeless. The heat and continuous sounds from vehicular traffic, as well as private nooks make these places popular for the unsheltered homeless.

The Seton Hill neighborhood sites showed that building cracks provided heat to homeless people.

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VIII
Conclusion

The 2011 Biennial Homeless Census is only a snapshot of the homeless predicament in Baltimore City. The increase in the number of homeless individuals, particularly among the unsheltered population, should be of concern to local officials and advocates for the homeless.

Every two years that the homeless census is conducted, those involved in the project build on the methods and procedures used in previous years. In this report, the research team expanded the area for the street count and visited key hospital emergency rooms to get a more accurate count. Volunteers also sought out sites outside the central city that were reported to be homeless encampments. Because of these improved methods, the census accounted for more of the unsheltered homeless population than it did in 2009.

The HMIS database also provided an accurate count of people who slept in shelters on the night of the census. This data system continues to be an important resource, tracking homelessness trends in the Baltimore City. For the city to achieve its ten-year plan to end homelessness, urban sectors in the areas of health, education, government, and business need to work together to address the most pressing needs of the homeless. Until an integrated solution is implemented, the conditions of the homeless will continue.

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A
Appendix

List of Homeless Service Agencies and Organizations Used in the Census Day Count ACC My Sisters Place Baltimore 24 Hour ES Baltimore Rescue Mission Baltimore City Department of Social Services Bea Gaddy Family Center Beans and Bread Outreach Program Franciscan Center Fusion/Power Inside Health Care for the Homeless, Inc. HOPE Drop-in Manna House Maryland Center for Veterans Education and Training, Inc. Our Daily Bread Employment Center Pauls Place

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B
Appendix

List of Emergency/Overnight Shelters and Transitional Housing in the HMIS data system 1814 Project Plase THP ACC Christopher Place ACC Fresh Start THP ACC My Sister's Place Lodge American Rescue Workers THP At Jacobs Well THP Baker Street Station Cottage Avenue THP Dayspring THP Earl's Place THP Ethel Elan Safe Haven Fred Ozanam House Geraldine Young @ AIRS Helping Up Johns Hopkins Program/Spiritual Recovery House of Ruth JHR Carrington House JHR VA Marian House THP MCVET THP Patrick Allison THP Prisoner's Aid THP for Women Safe Haven Salvation Army SAIL SHG- Lanvale Inst. THP South Baltimore Station VOA Pratt House THP YWCA Druid THP

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Appendix
List of Volunteers Makkah Timothy Sequoia Michele Eshy Muhammad Lia Nicholas Kia Maurice Barbara Kilan Lauren Adrienne Yvonne Marilyn Jitiba Kelly Cheryl Jocelyn

List of Homeless Providers Not Included in the HMIS

Baltimore Rescue Mission Overnight Shelter House of Ruth Emergency Shelter Karis Home Emergency Shelter Helping Up Johns Hopkins Program/Spiritual Recovery House of Ruth

Agara Akers Alexander Alston Amani Aminu Anderson Anderson Banks Barksdale Bates-Hopkins Bishop Bostic Breidenstine Bronner Brooks Brown Brown Bryan Bush

Mark Charles Gloria Dachon Pahua Mary Jeffery Cathy Derrick Richard Sophie Cynthia Vu Sade Toney Dwight Eric Hannah Olivia

Byrd Carpenter Carpenter Carroll Cha Chesnut Cook Cornwell Crawford Crawford Dagenais Daney Dang Demery Dixon Drewery Dunne Emple Farrow

Olivia Nancy Jennie Margaret Kristy Christine Jared Morgan Adam Scott Barry Michael Richard Jennifer Julia Erin Robyn Thomas Tessa Anthony Arturo Brian Rebecca John Tamisha Patricia Bryan Robin Dana Shirley Chad Amy Lisa Katie Faith Megan

Farrow Fenton Fiskum Flanagan Fornwald Garvey Gekonge Gilligan Gomez Gottbreht Graham Graves Gray Han Hartenstein Hayward Henry Hicks Hill-Aston Holmes Holmes Holmes Homer Hooker Jackson-Young Jakusz Johnson Johnson Johnson Johnson-Turner Kenney Kleine Klingenmeier League Savill Schwartz

Ruoxi Andrew Thibault Krystle Aquilla Kirk Ashley Randy Cheryl Gia TieShema Al Peter Derek Alexander Spencer Ethel Sarita Achike Tamora Barbara Carol Patricia Angela Mercedes Durga Patrick Dorren Jacqueline Alan Anthony Solomon Audrey Gina John

Lin Malone Manekin Martin Mitchell Mitchell Monie Mont Montgomery Montgomery Morgan Moye Murakami Musial Mustafa Nichols Nkwanyuo Olson Oranye Parker Patalics Payne Pittman Pressbury Proctor Pun Range Rennes Robarge Robinson Robinson Robinson Rogers Ruggieri Savage

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Appendix
Grace Carmen Meghann Gillian Joanne Angela Joe Katrina Nicole Tony Kimberly Tanya Frederick A. Tracey Shanell Cassandra Mary Pierre Raj Michael Tereina Chris James Tamara Jackie Christine Kelly Derrick Josephine Rudolph Jeff Ashley

Sherman Shorter Shutt Silver Silverstein Sluzalis Smith Smith Smith Smith Smolen Solomon Stamp Stevens Stevenson Stewart Stewart Stewart Stewart Strong Thomas Thomaskutty

Britina Andrea Donald Michael Janel Lawanda Laron Monifa Lamont Ellen Ciara Darwin Elizabeth MoHS Staff Gladys Wade Ingrid Vicky D'Andra Tammira Jeannette Co-Sponsor

Wharton Wheeler Whitehead Whiting Williams Williams Wilson Wilson Witherspoon Worthing Young-Thomas Zambrana Zurek

Timpson Torrence Truncellito Trzcinski Turner Turrentine Visuvasa Selvakuman Walker, III Walley Wharton

Apolonio Carver Duncan Franklin Pollard Smith Taylor

United Way of Central Maryland Chuck Tildon

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