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The Independent Thinker...

2010-04-15T08:38:14-04:00

THE INDEPENDENT THINKER’S CREED

I am an independent thinker. I believe that our Creator has endowed human beings, regardless of their standing in life, with a mind of their own and common sense to go with it; that Freedom of Thought is the greatest of our freedoms and is the bedrock upon which all of our other freedoms and inalienable rights rest, that even the Creator bows before the force of free will and thought.

As such, I believe that so long as I bring no harm to person or property, that I am entitled to my own opinion, formed on the basis of fact and reason and logic and not dictated to me by dogma, demagoguery, partisan politics, spin, political correctness, fashion, trend, tradition, persuasion, flattery, subterfuge, obfuscation, lies, or modern advertising; that my beliefs and opinions will rise or fall on their own merit, subject to the harsh light of their common good, and efficacy and contribution to knowledge and understanding.

I believe that political correctness is an inherent evil, cloaked in false sincerity and reasonableness by those with their own agendas; and that at its best, political correctness is nothing more than mob rule and the subjugation of the individual to group think.

As such, I am not impressed by your haircut, your clothes, your car, your political affiliation, whether you went to the “right” schools of learning, live in the “right” neighborhood, or you believe that the righteousness or “obvious moral superiority”of your beliefs should dictate or govern what I should think or believe. I judge men and women by the content of their character and the soundness of their ideas and beliefs when subjected to the light and tests of reason, logic, and common sense. I vote for the man or woman, not the party. You cannot buy me or bribe me to accept your position or your ideas; I am not a slave or a puppet.

I take my role and duty as a citizen seriously, and I believe that I alone am ultimately responsible for the protection of my freedoms; that it is my duty to hold those who represent me in the halls of our republic to the highest standards of integrity; that my vote is sacred and holy and that if I am too apathetic to hold others accountable, then I have no one to blame but myself for the actions of our elected officials that diminish my freedoms. I believe that effective representation is best served by my gaining a thorough understanding of the issues and that an uninformed vote is just as harmful as no vote at all.

I believe that I am not powerless; that my vote and those of my fellow citizens are nothing less than the ultimate thunder of the common man.

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A Bird's Eye View of th...

2010-04-21T17:31:52-04:00

A Bird's Eye View of the World's Water Supplies

(The information for this article has been gleaned from the April 2010 issue of National Geographic magazine)

Water a Taken for Granted Resource

People often take water for granted and think of it as coming from faucets only. But the reality of where it comes from and how it reaches its end users whether they are residential, agricultural, industrial, commercial, or recreational is far more complicated. Where one obtains their water depends on where they live. Water supplies come from ground water, surface water including lakes, rivers, or reservoirs, or desalinated ocean water.

Challenges to the Delivery of Safe Drinking Water

Reliable delivery of safe decent tasting water can pose daunting challenges, however. In a large number of Western cities in America and abroad, for example, 100-year old pipes leak on a regular basis which results in a 10% loss of precious H₂O. The City of Los Angeles alone in the summer of 2009 suffered the loss of tens of millions of water from dozens of burst city water pipes. The City has about 7,200 miles of water lines and mains that carry 600 million of gallons of water a day. The water lines and mains will require major repair and replacement, in the next 10-20 years, as many of the pipes are 50-75 years old, or more. Nationally, according to the American Water Works Association, the United States will have to spend an estimated 250 billion dollars over the next 20-30 years to repair rapidly aging water mains and pipelines.

Poor Infrastructure--A Major Impediment to the Delivery of Safe Drinking Water

Other problems, though, also impede the reliable delivery of water. In much of Sub-Saharan Africa, for instance, the delivery of clean safe drinking water is severely constrained by a lack of infrastructure.

"Water-Stressed" Ground-Water Supplies

Additionally, a growing number of cities and regions worldwide are becoming “water-stressed” as increasing populations place growing demands on diminishing ground-water supplies and global warming produces growing aridity in some areas. The bird’s-eye depiction of the water situation in some of the world’s major cities, which is written below, attempts to give the reader a quick overview of the severe constraints on water availability and access worldwide. For far too long as individuals and as nations we have taken the availability of clean safe water for granted and we continue to do so at our peril.

Perth, Western Australia—Set on the shores of the emerald green and shimmering Indian Ocean, Perth is stunningly beautiful but has been gripped in the steely grip of a drought for the past 10 years and is having to rely on desalinized sea water in increasing measure.

Kathmandu, Nepal—In the shadow of the towering Himalayas, many residents of Nepal’s capital and largest city have to rely more and more on ground-water supplies as the metropolitan area’s water supply is notoriously unreliable.

Kisumu, Kenya—Denizens of this city often obtain polluted water from Lake Victoria or from seasonal lakes and streams. Many residents of this city have to walk for miles every day just to obtain two or three buckets of water.

Johannesburg, South Africa—South Africa’s capital is one of the few cities in the world, with a population of more than one million, that does not have a major supply of water nearby; some of that city’s water is pumped from as far away as 30 miles.

Riyadh, Saudi Arabia—The Saudi capital is growing very rapidly and relies heavily on desalinated sea water drawn from the Persian Gulf.

Montreal, Quebec, Canada—The center of French-speaking Canada, as with many other cities, has rapidly aging water infrastructure and loses 40% of its deliverable water supply each year to leakage.

Atlanta, Georgia—Gripped by a severe drought for several years, access to water in Georgia’s capital and largest city became highly politicized in 2009 as the State of Georgia became locked in a struggle, with Alabama and Florida, over the use of water from Atlanta’ s primary water source which is Lake Lanier that is northeast of Atlanta.

Lima, Peru—Set on the Pacific Ocean, with a population nearing 8 million, Lima gets very sparse rainfall and has to depend very heavily on water from the Rio Rimac (River), other rivers, and stressed ground-water aquifers.

Beijing, China—This city of more than 10 million depends heavily on ground water pumped in from the northern province of Hebei which suffers from diminishing aquifer supplies of water, however.

Manila, Republic of the Philippines—The Philippine capital draws most of its water from the Angat Reservoir which, alarmingly, sits on a geological fault and is vulnerable to earthquakes.

Tokyo, Japan—On the very positive side, this megalopolis’s policy of repairing leaky pipes on the same day has lowered its leakage rate to a very low 3.6%.

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Uniting and Strengtheni...

2010-02-08T08:52:52-05:00

The USA Patriot Act is an acronym for Uniting and Strengthening America by Providing Appropriate Tools Required to Intercept and Obstruct Terrorism.The USA Patriot Act prevents the application of civilian justice principles from inappropriately applying to those designated enemy combatants taken in arms against this country. The constitutional procedural due process protections were devised in response to the opposite conditions, the inappropriate application of military justice principles to the civilian population. This application in 18th century New England in response to civil disobedience and unrest stimulated the very procedural due process protections. It should be patently obvious to even the most casual observer that the destruction of the World Trade Towers and the Boston tea party while both acts of terrorism, are not equivalent events. Similarly the detention of allied prisoners of war and the final solution were not equivalent whatever similarity there may have been between the final solution and Bataan or the Burma railway.

The Supreme Court has never countermanded or rescinded the acquiescence of Congress to the Presidential direction to conduct wiretaps or physical searches of foreign agents. This principle was devised during the cold war in response to attempts to undermine our liberty by totalitarian régimes. The Foreign Intelligence Surveillance Court was created by Congress during the cold war. The patriot act merely expands it to cover expanded contingencies in a post-Soviet world. This court was created by Congress in 1978 to approve requests for warrants to search or surveil foreign agents during the cold war. This was necessary because our counter-intelligence was never able to turn a soviet agent that did not volunteer. And every soviet agent that worked against their government was eventually sold out by american agents and executed by the soviets.^[1] The bench of this court is a panel of sitting federal district judges. This court meets in secret, a tradition established from counterespionage. Under the patriot act, the size of this court has been enlarged. The standard for approval of warrants in cases involving terrorism has been exempted from provisions meant to protect the same innocents that the patriot act was meant to protect by giving the federal government the capacity to conduct investigations of terrorists, using wiretap methods established in drug interdiction and law enforcement operations to counter organized crime. Lower courts have upheld the national security exemption from ordinary thresholds for obtaining warrants.

The primary challenges to the patriot act have been concerned with national security letters and electronic communication. The American Civil Liberties Union challenged the constitutionality of national security letters based upon the lack of provision to challenge a subpoena so procured. A reasonable expectation of privacy may be expected when one seals an envelope. This is why tampering with the mails is a federal offense. But, when leakage of radio signals between a portable phone and its base, and the imperceptibility of cell phone usage and internet communications is a known factor, then the expect ability of privacy is some what lessened. The interception and release of cell phone calls between republican leaders, and the existence of a plethora of internet security software demonstrates this. Furthermore, courts have ruled that where information is possessed and controlled by a third party, that expectation of privacy does not exist. This is why HIPPA laws were enacted to govern the use and distribution of personal health information. HIPPA stands for Health Insurance Portability and Protection Act. If there were an expectation of privacy with information controlled by a third party, HIPPA laws would be unnecessary.

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Addressing Homelessness...

2009-10-21T16:31:02-04:00

Written by Exiting Committee, ECHO (Ending Community Homelessness Organization) Front Steps, Austin, Texas

Executive Summary

Living on the streets is not only undesirable, it is dangerous: mortality rates are three times higher among homeless populations than among the housed, and the average age of death for this population ranges from 42 to 52^[1] compared to the average American lifespan of 78.^[2] The high cost of homelessness doesn’t just affect individuals, it also impacts the city. Although exact amounts are unknown, results from other cities suggest that Austin spends close to $40,000 a year per individual for chronically homeless users of public resources including hospitals, courts, jails, shelters, and the police. And while these services are all important, there is little evidence that they stop the harmful patterns associated with homelessness. There is evidence from other cities, however, that shows it is possible to save lives, reduce costs, and free needed public services from the burden of constantly cycling the same individuals through the system. Innovative and proven strategies – namely those of Housing First and Harm Reduction – are being used to great success to address homelessness, and it is time to bring them to Austin.

In order to isolate one of the most common and painful problems found in the population, this paper is focused on the overlap between homeless and alcoholism. Although many of these individuals probably have additional and overlapping addictions and/or mental illness, there is evidence from other cities of the benefit of paying attention specifically to this group. We estimate that over 1,200 people on the Austin streets suffer from some form of alcohol disorder, and outside research indicates the high cost of addressing the health problems and public inebriation that result. Other cities have implemented Housing First models with similar populations, and have reduced their costs by roughly $16,000 per frequent service user annually, and decreased the burden on public resources by more than 50%.

The purpose of this paper is threefold;

to initiate a conversation about the overlap between homelessness and alcoholism in Austin;
to introduce the concept of Housing First as a way to address a spectrum of solutions for homeless individuals suffering along the range of alcohol disorders, and;
to recommend the initial community steps needed to build a road map towards housing programs with appropriate support for homeless alcoholics and save vital public service dollars currently spent on these individuals.

Homelessness

According to the Housing and Urban Development’s (HUD) Continuum of Care for Homeless Assistance Programs, a 2008 count in Austin determined an approximate homeless population of 3,451. Although factors including the difficulty in obtaining accurate counts and the current economic recession^[3] make it likely that this number is far higher, for the purpose of this paper it will be used as our most recently assessed baseline homeless population. According to this same HUD report, Austin is short 1,800 units of housing for this population, which represents an unmet need of 52% for the homeless in our community.

The 2008 HUD report also noted that 919 (27%) of the 3,451 people were considered chronically homeless, a term that refers to an unaccompanied homeless individual with a disabling condition who has either been continuously homeless for a year or more, or has had at least four episodes of homelessness in the past three years.

Although national estimates place the percentage of chronically homeless between 10-23%, this population typically uses roughly half of the available services for the homeless.^[4] These resources include shelters, hospitals, emergency rooms, jails and prisons. Because Austin has an unusually high percentage of chronically homeless individuals, it can be assumed that there is a significant drain on public resources from this group. According to the same 2008 HUD report, Austin has 703 available emergency beds to serve the entire homeless population. At the time of the 2008 HUD count, 242 of the chronically homeless in Austin were at least temporarily in some sort of shelter, which left 677 unsheltered on the street or in a campground.^[5]

Alcoholism among the homeless

National estimates place the percent of homeless individuals who have problems with alcohol in the range of 35-40%, which is dramatically higher than the roughly 5%^[6] found in the housed population.^[7] Homeless individuals with alcohol problems often also suffer from mental and physical illnesses,^[8] and those with the most severe alcohol and drug problems are the least likely to exit homelessness for housing of any kind.^[8] The following chart illustrates what is known about the volume of homelessness in Austin, and its overlap with substance abuse. Although we cannot specify what numbers of homeless individuals have severe problems with alcohol abuse, the rate of chronic substance abuse of any kind is included because of the significant overlap between drug and alcohol problems in these populations.

Figure 1: Estimated number of homeless individuals with alcohol and drug problems

Attribution

Homeless individuals with the most severe, late stage forms of alcoholism are in serious danger of dying of their illnesses on the street, and they are typically the most frequent users of city resources including hospitals, police, and the court system. Symptoms of the disease at this point include a need to drink from morning until night, and an inability to seek food, shelter or aid. Almost always this precludes the ability to maintain any form of work. Unfortunately the need for alcohol can be so intense that in many instances homeless addicts at this stage will resort to drinking harmful substances including mouthwash in order to supply their bodies’ need for alcohol. Statistics on the percent of overlap between chronic homelessness and severe, late stage alcohol abuse are unknown, but for those that are chronically homeless, this percentage clearly rises dramatically from the 35-40% found among the total homeless population.

Cost of frequent service users from other cities

Although Austin is yet to conduct a comprehensive analysis of the cost of services spent on the homeless in our community, much can be learned from studies in other cities around the country. According to the National Alliance to End Homelessness, Portland, Oregon compared the city’s costs before and after placing 35 people with high levels of resource use into permanent housing.^[9] Each cost Portland over $42,000 annually before they were housed, and afterwards - even with housing costs - they dropped to less than $26,000 each. New York City determined a similar average individual pre-housing cost of $40,000 for their population of mentally ill homeless people, and also saw costs drop by over $16,000 per participant with the use of permanent housing solutions.

Closer to home, Dallas recently conducted an analysis of their “frequent users” of public resources, and found that the city spends roughly $50 million dollars a year on the homeless in the city.^[10] When the contributing agencies tallied their costs separately, the results point to the tremendous drain that homelessness places upon particular community services. One central hospital estimated it spent $15.6 million dollars annually treating homeless individuals, while there were price tags of $10.6 million on the county jail, $5 million on ambulance services through the Dallas Fire-Rescue Department, $2 million spent on court costs, and close to $1 million for on downtown arrests.

Consider the example of an arrest of a public inebriate. According to the Dallas figures, it costs $30.91 an hour for the police to deal with these situations, and an average of two hours to book an individual into jail for this kind of offense. Add that $61.82 to the average daily state correctional costs of $47.50 per offender^[11], and a single arrest and night spent in jail costs taxpayers well over a hundred dollars. When these numbers are multiplied by the volume of chronically homeless individuals facing severe alcohol problems, and the number of times annually that each may be arrested for public intoxication, it is clear how expensive the cycle becomes. Furthermore, because most of the costs associated with cyclically processing and handling the homeless population do not contribute at all towards solving the problem, this money is being thrown towards a pattern that likely ends only with an individual’s death.

Evidence based practices that work

There are evidence-based programs from around the country that are making great strides with this population, however, and it is possible now to identify the best practices in the field.

Harm Reduction

Many of the recent success stories in housing for the homeless fall under a general philosophy called Harm Reduction, which meets substance abusers “where they’re at” without trying to immediately impose abstinence. Although the long term goal is to stop the addictive behavior, Harm Reduction aims practically to do exactly what it says: reduce the level of harm against the individual. These reductions may be large or small, but they work with what the participant is willing and able to offer towards their own recovery. Two well known examples of Harm Reduction strategies within an illegal drug context are methadone clinics and needle exchanges, both of which are used to decrease the risks associated with heroin addiction.

The strategies associated with Harm Reduction for alcoholics are in stark contrast to the sobriety centers still used across the country to quickly – but only temporarily – dry out individuals arrested for public inebriation. Although these programs, often referred to as drunk tanks, may produce rapid sobriety, it is a fleeting achievement that in some cases can actually endanger a severe alcoholic with extreme levels of dependence.

When applied specifically to alcohol abuse, Harm Reduction aims to decrease the risk of dangers associated with the disease. Because alcoholism can cause a myriad of physical and mental problems, improving overall health is a major goal of Harm Reduction with alcoholics, and reducing drinking levels and helping addicts attend to necessary medications and treatments are ways to accomplish this. Although there may be a long term goal of total withdrawal, Harm Reduction acknowledges that some progress is better than none, and that it is preferable to reduce drinking and improve overall wellness than to fail to impose sobriety.

Housing First

Housing is also healthcare. There is a growing body of literature – and proof in cities across the country – that the most effective way to solve the problem of chronic homelessness and to improve the quality of life for these individuals is to begin treatment by first providing affordable housing that has low barriers for entry. Housing First provides a homeless person with permanent housing with services immediately rather than place the homeless person in a shelter or transitional housing unit. It assumes that housing stabilization is key in the return of the individual or family to independent living and that needed supportive services can effectively be provided to the client either on site or at agency offices^[12]. There are no preconditions for Housing First programs, other than that the individual demonstrates they will be able to live alone.

Housing First was developed by the nonprofit Pathways to Housing in New York City, which started using the model after their inception in 1992.^[13] For the past 15 years, communities across the nation have implemented Housing First as a best practice model for working with chronically homeless individuals, many of whom have additional problems such as substance abuse, and mental or physical illnesses. Studies and evaluations of programs around the country point to the power of these strategies to decrease both homelessness and community costs associated with the use of public emergency services. Housing First models that place the chronically homeless into permanent housing can lead to reductions as high as $18,000^[13] per person annually. Furthermore, research shows that roughly 85% of Housing First residents remain housed in a stable environment, and therefore off of the streets and out of the chaos that is included.^[14]

The following terms are used to describe particular housing options, and can fall either within or outside Housing First models. To qualify as Housing First programs, they must provide permanent housing solutions without barriers to entry based on participation, sobriety, treatment, etc.

Supportive housing: Supportive housing provides both a stable place to stay and necessary services as part of the residency arrangement. This enhanced option for accommodation is provided to help homeless individuals with a disability whose barriers to housing are complex, and for whom independent living will still require a great deal of support. The services provided can include extensive case management, where residents are in regular communication with someone who checks in on their situation and provides assistance when needed. Additional services such as treatment are offered but are not required.
Options for housing locations:
Scattered site housing: Scattered site housing, which may or may not fall under a supportive model, is designed for individuals who are ready to be placed throughout the community either transitionally or permanently in low-income apartment complexes. There may be only one or two scattered site apartments for the homeless in a particular complex, and while the residents may not have on-site services, they may still have access to case managers and related services through their sponsoring organization.
Fixed or single site housing: Fixed or single site housing is designed as a permanent, group-based home specifically for homeless individuals facing particular disabilities such as alcoholism and mental illness. These homes generally house up to 100 small, single-room occupancy apartments and provide staff on hand 24 hours a day to assist as needed with medical issues and other problems.

Different individuals will need different resources, and the appropriate option may be related in part to the level of alcohol addiction faced. The higher the level of dependency, it can be assumed the higher the level of vulnerability to harm. The following chart uses the concept of vulnerability – one’s susceptibility to dangers on the streets – as a way to begin examining what types of housing may be best suited for each person.

Figure 2: Levels of vulnerability and appropriate housing options

Attribution

Vulnerability terms adapted from the “Vulnerability Assessment Tool” provided by the Downtown Emergency Service Center, Seattle, WA.

*Transitional housing refers to more short-term intensive programs that address specific needs, and it is not a Housing First model due to the impermanence of the residency. There are opportunities, however, for these types of organizations to become pathways into Housing First options, and certain individuals with severe illnesses, for example, may require this intermediate step before being able to live alone.

What other cities specifically address homelessness and alcoholism?

The popularity of Housing First and Harm Reduction models is spreading across the country as evidence of their efficacy increases, and many cities already use them to specifically tackle the issue of housing homeless individuals with alcohol dependency problems.

Seattle: Pioneering a single site Harm Reduction and Housing First model with alcoholics

Seattle’s Downtown Emergency Service Center (DESC) opened in 2005 as one of the first Housing First, single site homes specifically designed for chronically homeless late stage alcoholics. While other services in Seattle selected residents based on overall vulnerability, DESC offered its 75 rooms to the individuals putting the greatest strain on city resources including hospitals, jails and shelters. Within the residency, 26 of the units are without doors or ceilings, and are designed for individuals who require closer monitoring and cannot be safely left unattended in a closed single occupancy apartment. This program fits a Housing First model because it provides permanent housing, and does not require individuals to prepare for or qualify with housing readiness of any sort.

In the four years since DESC opened, the city reports they have saved 1.8 million dollars in the reduction of emergency room visits alone. Furthermore, the longer individuals were enrolled in the program, the greater the reductions in cost and usage of services. In a 2009 study in the Journal of the American Medical Association (JAMA), researchers reported that^[15]:

When compared to individuals on a waiting list to get into the home, the cost rate for residents was reduced 53% in the alleviation of police, hospital, and jail services.
When the average monthly per person cost of $1120 is subtracted from the $3569 saved over the control group, there was a total mean cost offset of $2449 a person per month.
If these savings are extended over 12 months and 75 residents, it leads to an annual reduction in costs of over 2.2 million dollars.

Despite the fact that residents are allowed to drink alcohol in their rooms, alcohol use also dropped from an average of 15.7 drinks daily to 10.6 after 12 months. Again, these rates decrease alongside continued time in the program. In addition, researchers also found a statistically significant reduction in the number days the residents reported intoxication.

While there was some initial rejection of the DESC by potential neighbors, the project is considered a huge success, and many of the former critics adopted a more positive view after seeing how successful and non-intrusive it was in their neighborhoods.

Ottawa: Using Harm Reduction to minimize the risk for homeless alcoholics

Before Seattle implemented their extensive Housing First plan for homeless alcoholics, in 2001 Ottawa built a more modest program based on the Harm Reduction model. Unlike Seattle, they did not provide separate rooms that resembled permanent housing for their residents, but instead created a shelter of beds and a system to dispense alcohol hourly in small medical dosages. As with the program design, their results were more modest than Seattle’s but still point to the power of these types of programs to reduce city costs and improve the quality of life for its residents. The population targeted was one of the most vulnerable in the city:

the average resident indicated their alcoholism was ongoing for 35 years;
most reported daily use of alcohol through the consumption of at least one non-beverage such as mouthwash;
the majority indicated they had tried at some point to abstain, or had been through detoxification programs was zero long-term incidence of success; and
88% of the participants also had some form of mental or physical illness.

The results from a study in the Canadian Medical Association Journal indicate clear benefits for the individuals involved in the program^[16]:

the average daily consumption of alcoholic drinks dropped from 46 to 8;
most participants indicated they had improved qualities of sleep, personal hygiene, nutrition and health;
employees reported that 88% of participants complied with their prescription medication requirements;
problems with the police decreased 51%; and,
trips to the emergency department decreased 36%.

The program cost $771 Canadian per individual monthly, which was offset by reductions in emergency department, hospital, and police services of a combined $447 monthly. While the program did not pay for itself, the positive improvements in the lives of the residents and the reduction of burden on needed community services indicate that it provides a very valuable resource in Ottawa. Furthermore, it points to the power of this type of program to change lives. As demonstrated even further in Seattle, the potential for positive outcomes increases when a harm reduction model is paired with Housing First in a more significant program for residents.

San Jose: Building a scattered site Harm Reduction and Housing First plan for alcoholics

EHC LifeBuilders in San Jose, California also has a Housing First program targeting chronically homeless alcoholics, but they implemented a scattered site version that disperses individuals throughout the community. Their Housing for Homeless Addicted to Alcohol (HHAA) program places alcoholics directly from the streets into permanent, supportive, affordable housing that includes assistance with basic needs and access to counseling for substance abuse. This program fits a Housing First model because the housing is permanent, and because individuals do not have barriers to entry based on treatment requirements. Although official evaluations of the program are not yet available, initial results indicate its success at addressing this particular population.

How do other cities pay for these services?

In a comprehensive review of cities targeting reductions in chronic homelessness, the HUD found commonalities in the way the most successful programs were funded. Diversity of funding sources was extremely important, and they write that reduction goals will not be achieved if only Federal aid is utilized for services. They found that the integration of Federal, state, and local dollars, and the inclusion of mainstream public agencies was vital to the success of most initiatives. One example provided for non-Federal funding is the contribution of downtown business organizations, which they connected to success in Birmingham Alabama, Columbus Ohio, Philadelphia and San Diego. For a complete list of the HUD recommendations, please see Appendix A.

Substance abuse intervention programs in Austin now

While there are no Housing First options for homeless alcoholics in Austin currently, the city does have a number of substance abuse programs that provide emergency, transitional, and permanent housing to individuals in the community. However, other than emergency shelter beds many of the other housing options are not open to individuals with demonstrated alcohol or substance problems. According to the 2008 HUD report, the following housing options were available for the overall homeless population:

Figure 3: Available Beds in Austin

Attribution

There are several alcohol intervention programs in Austin that provide treatment services to the homeless. The following may not be an exhaustive list of what is available, but it demonstrates the types of programs that exist currently.

Recuperative Care

Recuperative Care is designed for homeless individuals who need home health care after being released from the hospital. The purpose of the program is to improve patient health outcomes, decrease the cost of hospital recidivism, increase the use of community clinics rather than hospital emergency rooms and end the clients’ homelessness. Substance abuse intervention is also included. The program places people in a nursing home during their illness, then offers transitional housing to almost all of its clients, and will keep the clients in transitional housing until permanent housing is found. Sobriety is not a requirement of continued housing; however, more permanent housing needs to be identified because the program’s capacity for transitional housing is nearing exhaustion. Most of the participants face significant substance abuse problems along with their illnesses, and the program has seen many become sober as a result of the housing, support, and counseling provided.

Although 182 patients were initially recommended for the program, there was only space for 30, and of these 22 exited successfully. Six clients had a history of frequent use of the ER; one of these had 30 visits in one year, another had 16 in one year, another 14 in one year. For these heavy users, admission to the RCP resulted in a clearly demonstrated reduction in ER visits. Two success stories illustrate the power of this program:

One patient who averaged 15 ER visits per year for over five years had only 2 ER visits in the year following his discharge from the RCP. It is worth noting that neither of these visits was related to alcohol abuse, when very nearly each of the 90 ER visits in the previous 5 years had been. This patient now has housing, steady income, and health insurance, in addition to his sobriety.
Another of these frequent users has reduced his ER use from 14 visits in the 6 months prior to his RCP admission to only 3 in the 12 months following his discharge from the RCP. Mental health issues and drug use contributed to this client’s poor health and poor self care over the years; however, he is no longer using illicit drugs, is receiving mental health services, and is continuing to meet regularly with the RCP case manager who has assisted him to obtain SSI income and placed him on the waiting list for public housing, which he should obtain within the next several months.

The Recuperative Care program cost $284 per day. As more clients exit the program a study will be conducted to determine the cost savings to the community.

The Salvation Army

The Salvation Army Adult Rehabilitation Center is a Christian-based residential program for men who commit to complete sobriety from alcohol and drugs as a condition for entrance into the home. They must also agree to six full months of treatment at the center, and are tested by urine and breath throughout their stay to ensure that they are complying with the drug and alcohol free rules. Services including work training, counseling, and substance abuse classes are available to residents, along with religious courses to help encourage participants to embrace Christianity during their treatment.

Project Recovery

Project Recovery is aimed at individuals repeatedly arrested for public inebriation who are given a choice between committing to this substance abuse program or going to jail. Those who opt for treatment are admitted to a 180-day program that includes sobriety, mandatory substance abuse counseling, and services aimed at reestablishing normalcy post-addiction. Only the first 90 days include residency, after which successful graduates are given an apartment and case management from the organization. Those individuals who decide to withdraw from the program partway through are required to return to jail.

Alameda House

Alameda House provides a 90-day transitional housing program to help the mentally ill homeless, as well as the mentally ill who are on probation and have substance abuse problems. The goal of the program is to teach the necessary skills for independent living, and to work with a caseworker during the time to encourage healthier lives.

Recommendations

In order to respond with both empathy and community logic to the citywide problem of alcohol abuse among our homeless population, Austin requires a spectrum of services intended to address this issue across all the levels of abuse. Those with lower stage alcohol problems require a different set of resources than those with the most severe forms of dependency. While some homeless individuals will benefit from and respond to transitional housing paired with substance abuse programs, others may require a more intensive, supportive environment that provides on-site nursing, case management, and additional resources.

In order to initiate a plan to address these problems, we recommend that the city conducts four initial steps;

Determine the service gaps that Housing First options will fill using nationally respected surveys to identify the subpopulation of homeless individuals with alcohol disorders, and to determine the overall level of vulnerability and need in the city;
Assess the cost of frequent service users and explore ways to redirect current funding towards Housing First options for middle and late stage alcoholics under a Harm Reduction model;
Evaluate the funding sources used in more successful cities and determine what new resources may be applied in Austin, and;
Create support, awareness, and outreach among business, community, and social service leaders to establish a long-term plan to eliminate homelessness among alcoholics and champion the project in our city.

1. Determine the service gaps

Referral: One of the best ways to identify the population is through the services currently being over-used by chronically homeless alcoholics. The Downtown Austin Community Court and Austin Resource Center for the Homeless (ARCH) both have lists of the “frequent service users” who repeatedly and consistently appear in their programs. ARCH, for example, has identified a small subset of shelter residents who utilize their basic needs services (shower, restrooms) but do not access the case management services that would help them in ending their homelessness. Shelter managers have observed a staggering overlap with alcohol abuse among this population.

Self-identification: Some individuals may find out about proposed programs and request participation or residency based on the desire for supportive housing and services. While the fiscal goals may dictate that participants in some services should be among the highest users of community services, if someone wishes to participate and fits the guidelines for entry, they will be admitted if space remains.

Survey Tools: As part of the implementation of the spectrum of services for homeless alcoholics in Austin, we recommend that Austin implements one or more of the best practice assessment tools used to collect data on the numbers, needs, and distinctions among our local homeless population. In particular, we would like to identify those who are frequent service users but do not access available services. Two possible examples are described below.

The Vulnerability Index: Developed in cooperation between Dr. Jim O’Connell and the nonprofit Common Ground, the Vulnerability Index is an inexpensive and quick way to gather a great deal of information about the homeless community and the level of risks faced by its members. The VI, which consists of 45 questions, is administered early in the morning over the course of several days by a team of volunteers, under the management of an expert. Homeless individuals are asked to participate but may refuse, and if comfortable, are digitally photographed in order to create an inventory of the population.

The VI is based on a series of eight variables that, when individually or collectively paired with homelessness, dramatically increase the probability that an individual will die prematurely on the streets. These factors are:

more than three hospitalizations or emergency room visits in a year
more than three emergency room visits in the previous three months
aged 60 or older
cirrhosis of the liver
end-stage renal disease
history of frostbite, immersion foot, or hypothermia
HIV+/AIDS
tri-morbidity: co-occurring psychiatric, substance abuse, and chronic medical condition.

Other cities have used the VI to rank order the most vulnerable homeless individuals, and to immediately target these people for services. Although the primary goal of this paper is to present the idea of a focus on homeless alcoholics, the VI would provide a quick and inexpensive way to gauge the level of vulnerability in the overall population, to see how extensively proposed services for alcoholics would alleviate the overall degree of vulnerability in the community, and to determine how to precede with the construction of a spectrum of services for these individuals.

One way to gather momentum behind the entire spectrum of services for alcoholics is to raise awareness about the specific needs in Austin. The Vulnerability Index is a great way to draw greater attention to the issue of homelessness and its associated morbidity levels. By bringing these issues to light, individuals in the community will begin to notice, consider, and care for the homeless around them more than before they had specific information about the population as well as individual stories of struggle and tragedy.

Portland Oregon recently discovered the power of the VI when they conducted the survey as part of a 10 year plan to end homelessness in their city. When the results were tallied, they found surprising and disturbing data about their homeless populations. Higher levels of vulnerability, and specifically tri-morbidity, were found than in other municipalities in which Common Ground worked. Newspaper articles highlighted the findings, public attention was raised, and city officials called for additional programs as a result.

The Vulnerability Assessment Tool: Developed by the Downtown Emergency Service Center in Seattle, the Vulnerability Assessment Tool is a short but powerful tool that case managers and shelter staff can use to quickly assess an individual’s level of vulnerability. The VAT examines a broad range of characteristics that include:

Survival Skills
Basic Needs
Physical/Medical Condition
Organization/Orientation
Mental Health
Substance Use
Communication
Social Behaviors
Homelessness

The staff member who fills out the form has a very explicit scale for each factor that allows them to carefully rate the individual’s impairment, and the probability that they will face increased difficulties on the street. This assessment could be an important part of the identification of clients for many of the Housing First options proposed in this paper, and will help emergency shelter staff and other service providers isolate those who require additional, immediate aid. For more information on this assessment, please see Appendix B for the full description of each scale.

2. Determine the cost of frequent service users

Another way to increase public support for these projects is to conduct a comprehensive study of the cost to taxpayers of the most frequent users of public services including hospitals, ambulances, police, courts, and prisons. The burden on all of these resources will likely be reduced with the advent of increased Housing First and Harm Reduction-based programs for homeless alcoholics, and pointing out the current price tag for their life on the streets may motivate community members to support their initiation. Work from other cities indicates that there can be initial resistance to the idea of providing housing to homeless alcoholics, but that the cost benefits and ease on city services are persuasive to those not motivated by the call for housing as healthcare.

3. Examine funding sources in Austin and other more successful cities

The HUD recommendations referenced earlier call for a varied and diverse set of funding sources in order to fully implement successful programs that reduce chronic homelessness. A detailed evaluation of the resources used in more successful cities will help clarify the best practices for funding new initiatives, and make it easier for Austin to determine what new resources may be applied here to both create and maintain a spectrum of services for homeless alcoholics.

4. Create support, awareness, and outreach

In order to carefully review the results of the first three steps and spearhead support for new programs in Austin, we need to bring these innovative ideas to the public with the full approval of a wide range of individuals. Business, community, and social service leaders should help fashion the long term plan, and communicate the need and benefits to the city. By building collaboration among many groups, it will emphasize both the importance and the widespread support of the project.

Conclusion

Even without a comprehensive survey of our homeless population, we know there are hundreds of individuals in danger on the Austin streets. Although we have many services in place to target those without housing, Austin needs a long-term plan rooted in proven Housing First and harm reduction strategies to handle the dramatically overlapped problems of homelessness and significant alcohol abuse. And with the guidance of other cities like Seattle and Portland, our community can provide more to the most vulnerable members of the homeless population, save valuable resources in our community, and increase the quality of life and hope for a better future for individuals that desperately need our help.

Appendix A: “Key Elements of Success to Reducing Chronic Street Homelessness”

U.S. Department of Housing and Development, Office of Policy Development and Research

The following were determined to be connected to success in cities where chronic homeless was reduced significantly as part of community-wide long term plans:

A paradigm shift in the goals and approaches of the homeless assistance network.
Setting a clear goal of reducing chronic street homelessness.
Committing to a community-wide level of organization.
Having leadership and an effective organizational structure.
Having significant resources from mainstream public agencies that go well beyond homeless-specific funding sources.
A trigger event that was the catalyst for developing the preceding five elements.
Significant involvement of the private sector.
Commitment and support from mayors, city and county councils, and other local elected officials.
Having a mechanism to track progress, provide feedback, and support improvements.
Being willing to try new approaches to services.
Having a strategy to handle and minimize negative reactions to locating projects in neighborhoods (“Not in my neighborhood” NIMBY responses).

Appendix B: The Vulnerability Assessment Tool

The Downtown Emergency Service Center, Seattle WA

The following are the nine scales used to rate individuals’ level of vulnerability:

Survival Skills: Vulnerability, safety, dependency on others, ability to maneuver independently in safe manner, judgment

Attribution

Basic Needs: Ability to obtain/maintain food, clothing, hygiene, etc.

Attribution

Physical/Medical: Physical limitations or medical conditions that impact person’s ability to function

Attribution

Organization/Orientation: Thinking, Development Disability, memory, awareness, cognitive abilities – how these present and affect functioning

Attribution

Mental Health: Issues related to mental health status, MH services, spectrum of MH symptoms & how these impair functioning

Attribution

Substance Use: Issues related to substance use, services, spectrum of substance use & how use impairs functioning

Attribution

Communication: Ability to communicate with others, when asked questions, initiating conversations

Attribution

Social Behaviors: Ability to tolerate people & conversations, ability to advocate for self, cooperation, etc.

Attribution

Homelessness: Length of Time Homeless

Attribution

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