"Homeless episodes result from a combination of factors that accumulate over the lifecourse"

One of the great things about working for an agency that  does a lot of research into areas of interest to me; poverty, homelessness, social issues, etc., is that I find treasure in the form of great pieces of literature just about every time I wander into work.   The article below by Jocelyn Apicello is one of those great pieces and I hope you'll spend the time required to read it.  I suspect by the time you reach table 1 you'll be hooked; it didn't take me but a few sentences.....



A Paradigm Shift in Housing and Homeless Services: Applying thePopulation and High-Risk Framework to Preventing Homelessness

Jocelyn Apicello*
Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, 722 W. 168th Street, 5th Floor, New York, NY 10032, USA

Abstract: Prevention is critical in any effort to end homelessness. Unfortunately, the practice of homelessness prevention is still in its infancy and there is little science base for its implementation. Risk factors for homelessness have been identified at multiple levels: the individual, institutional, and societal levels. Addressing all three in prevention practice is necessary. The population/high-risk framework is the most appropriate framework for conceptualizing how to design programs and policies to prevent homelessness because it draws attention to the need for direct intervention among those at most risk, and also for modifying the overall context. This review of the literature and technical reports points to a number of strategies that demonstrate preliminary effectiveness or are in need of rigorous evaluations. Reductions in homelessness as a result of targeted, high-risk approaches alone are achievable, but will be short-lived unless low-cost and affordable housing and income are addressed at the population level. Simultaneous implementation and evaluation of both population and high-risk prevention strategies will bring us closer to reaching our goal of ending homelessness.

INTRODUCTION
Prevention is critical in any effort to end homelessness. The past three decades of homeless services have focused resources primarily on managing and treating homelessness by providing crisis services to people once they become homeless. More recent policy and program development has emphasized ending chronic homelessness, focusing on the estimated 10-20 percent of people who have very long or recurrent spells of homelessness. However, homelessness is not simply a temporary emergency or a problem of those few who experience extended time without their own home; it is an entrenched phenomenon in the modern world, not only in the United States, but in other developed nations as well.

The current U.S. housing and economic crisis [1-3] brings the need for homeless prevention to the fore. This crisis could lead to thousands of households losing their homes to foreclosure and many more to face financial struggles as a result of rising unemployment. Given the increasing number of people experiencing housing loss and homelessness and the opportunity created by the $1.5 billion included in the 2008 American Recovery and Reinvestment Act for homelessness prevention, diversion and re-housing activities, we are at a critical moment for a paradigm shift in housing and homeless policies to take place.

Unfortunately, the practice of homelessness prevention isstill in its infancy and there is little science base for itsimplementation.1 There is no consensus among experts in the field on what the most appropriate approaches are for preventing homelessness. Furthermore, few methodologically rigorous evaluations of homeless prevention programs have been conducted. Most evaluations lack an adequate control group or are not randomized, have no or limited follow-up, and rely on descriptive case studies. Results from these studies can be misconstrued and misunderstood as prevention because they presume perfect success rates for anyone receiving services (i.e., that 100% of people who received the intervention would have been homeless had they not received the intervention). Additionally, well-executed cost-benefit studies that can establish marginal cost savings of prevention programs are rarely performed. With funding sources increasingly expecting the implementation of best practices and evidence-based programming, more effort must be taken to develop sound program models and execute state-of-the-art evaluations.

Current circumstances in the housing and financial markets have created a critical opportunity to bring prevention of housing loss to the foreground. In this paper I will argue for the adoption of a prevention-oriented approach to homeless services by employing the population/high-risk prevention framework. First, I will outline why preventing homelessness is important and timely. Second, I will describe the science of prevention as it applies to homelessness using the social epidemiological population/high-risk prevention framework. Third, I will review selected population and high-risk prevention interventions that have been applied to the problems of housing and homelessness. Finally, I will provide recommendations for clinical practice, program development, policy and research.

WHY PREVENT HOMELESSNESS?
The extent of the crisis of homelessness makes prevention urgently important. According to current estimates, there were approximately 672,000 sheltered and unsheltered people experiencing homelessness in the United States in January 2007 [4]. Early research has shown that approximately three to seven percent of adults have had a significant homeless experience during their lifetime [5]. More recent research estimated that the lifetime prevalence of homelessness in the U.S. is 6.2 percent [6]. The number of homeless families continues to rise since the 1980s, and families currently represent approximately 40 percent of the homeless population [4, 7, 8]. Burt and colleagues [9] estimate that 10 percent of poor families experience homelessness annually, resulting in 1.3 million children living in shelters or on the streets.

An extensive list of negative health and socialconsequences are associated with homelessness [10-13],making preventing its onset and duration a critical goal for the health and well-being of individuals and communities. Research suggests that homeless experiences can exacerbate existing illnesses, impede recovery, and provoke newillnesses [10, 12, 14-16]. Mortality among clients served by Health Care for the Homeless projects in 19 cities was estimated as 3.1 times that of the general U.S. population [16], and in New York City age-adjusted mortality rates of homeless individuals were four times those of the general U.S. population and two to three times those of the general population in New York City [10]. Compared to poor, housed children, homeless children have worse health, more developmental delays, more anxiety, depression andbehavior problems, poorer school attendance andperformance, and other negative conditions [17, 18].O’Flaherty [19] infers that “a community with a history of more homelessness in the past is likely to be a community with more disabilities in the present, and so is likely to experience more homelessness in the future.” Breaking the cycle of homelessness can help foster healthy individuals and communities.

The financial costs of homelessness are also sobering. The U.S. federal government spends $1.9 billion every year on dedicated homeless services, and that is not counting the funding that assists homeless families and individuals from mainstream programs, such as Medicaid, TANF, ormainstream housing programs [20] or resources provided by private, non-profit and faith-based organizations. Thus, the burden of managing homelessness is not only borne byhomeless service providers, but also other mainstream and social service providers. People who are homeless are more likely to access costly health care services [21, 22] and spend more time in jail or prisons [11, 23]. Furthermore,emergency shelters too often serve as long-term housing, which costs HUD’s Emergency Shelter Grants program over $8,000 more than the average annual cost of a federalSection 8 housing subsidy [24].

WHY SHIFT TO A PREVENTION FOCUS NOW?
With decades of research on the individual, social and economic costs associated with homelessness, there have been several recent initiatives that focus on ending it. For example, between 2001 and 2007, the U.S. Department of Health and Human Services (DHHS) convened a Homeless Policy Academy Initiative, in partnership with the U.S. Departments of Housing and Urban Development (HUD), Veterans Affairs, Labor, and Education. The Initiative was designed to help state and local policymakers improve access to mainstream services for people experiencinghomelessness. In 2000, the National Alliance to End Homelessness (NAEH), a nonpartisan organizationcommitted to preventing and ending homeless in the U.S., released a comprehensive Ten-Year Plan to EndHomelessness to address the challenges that localjurisdictions face. In just a few years, over 300 localities have drafted plans to end homelessness [25]. Although the large majority of 10-year plans focus on ending chronic homelessness, their initial success at putting homelessness back on the agenda of local policymakers has created a unique opportunity to draw attention to prevention.

Preventing homelessness is also timely with respect to federal, state, and local emergency response procedures to both natural and unnatural disasters. For example, in 2005, Hurricane Katrina displaced over 600,000 individuals across the Gulf Coast in the month following the storm and destroyed nearly 228,000 homes in New Orleans, Louisiana [26]. The slow-to-develop plans to rebuild affordable housing units and provide people with housing subsidies have been grossly inadequate. One of the consequences of this event has been the refocusing of national attention on the affordable housing crisis, the burden of which is disproportionately borne by low-income and minority communities, and its role in creating homelessness.

Moreover, the recent housing crisis is wreaking havoc on more then just the stock market, the housing market, and our economy: thousands of individuals and families face foreclosure and increasing material hardship. A recent U.S. Conference of Mayors report indicated that U.S. cities are reporting significant increases in homelessness as a result of the foreclosure crisis, and that many of them are homeless for the first time after losing their home [27]. CNN reports that authorities in Santa Barbara, California, have made 12 gated parking lots available to families living in their cars – the first such program in the U.S. [28].

As foreclosures and general housing instability are expected to rise, programs that help prevent individuals and families from losing their homes and facing homelessness are imperative. In February 2009, Congress passed the nearly $800 billion American Recovery and Reinvestment Act, which includes $1.5 billion for homelessness prevention and re-housing for households who are homeless or at risk of homelessness. This critical funding could provide theopportunity to transform housing and homeless assistance from a treatment-focused agenda to a prevention-focused one.

EMPIRICAL STUDIES IDENTIFYING RISKFACTORS FOR HOMELESSNESS
Prevention science is based on the notion that risk and protective factors that are empirically derived can predict the likelihood of outcomes. Over two decades of research on the risk factors associated with homelessness has uncovered a range of points to intervene—precursors to the development of prevention programs. Common to all studies is the fact that people experiencing homelessness live in extreme poverty.

Numerous forces that contribute to increases in poverty play a role in the existence of and increase in homelessness. People who are on the losing end of these fundamental forces—for example, unemployed people, people with no assets, or people with physical, mental or developmental disabilities—are then vulnerable toexperiencing homelessness. However, as not all persons living in poverty experience homelessness [9, 29, 30], many studies have attempted to understand the factors that increase the risk of homelessness among poor persons.

These empirical studies largely focused on identifying characteristics at three different levels: (1) the individual level: single individuals or families who are currently homeless, formerly homeless or at-risk of homelessness; (2) the institutional level: community institutions or facilities that can be public or private and that provide either formal or informal services to people who are homeless or at-risk of homelessness; and (3) the social level: the characteristics of larger social systems, which include social, economic, political and cultural forces.

Table 1 contains a summary of risk factors forhomelessness in the U.S. at the individual, institutional and social levels. Importantly, homeless episodes result from a combination of factors that accumulate over the lifecourse: Individual vulnerabilities, taken within the context of institutional experiences and the social environment,contribute greatly to the complexity of the problem of homelessness, particularly when it comes to predicting who is most likely to become homeless in the first place [31]. In fact, it may be the conjunction that counts; in other words, being the wrong person in the wrong place at the wrong time [32]. A concerted effort is needed to prevent homelessness before it occurs by addressing root causes in the general social environment. Additionally, preventing homelessness among identified high-risk groups, such as persons with mental health, substance abuse or trauma histories, require targeted interventions that go beyond what is done to improve the social environment for the general population. Addressing these multiple levels from a prevention-oriented approach, rather than a crisis management and rehabilitative treatment approach, requires a comprehensive conceptuali-zation of prevention that addresses the fundamentalcontextual and individual causes of homelessness.

OVERVIEW OF CONCEPTUAL PREVENTION FRAMEWORKS
Preventing homelessness requires an appropriate framework to guide the development of prevention
Table 1. Summary of Empirically Identified Risk Factors for Homelessness. People who are on the losing end of these fundamental forces—for example, unemployed people, people with no assets, or people with physical, mental or developmental disabilities—are then vulnerable toexperiencing homelessness. However, as not all persons living in poverty experience homelessness [9, 29, 30], many studies have attempted to understand the factors that increase the risk of homelessness among poor persons.

These empirical studies largely focused on identifying characteristics at three different levels: (1) the individual level: single individuals or families who are currently homeless, formerly homeless or at-risk of homelessness; (2) the institutional level: community institutions or facilities that can be public or private and that provide either formal or informal services to people who are homeless or at-risk of homelessness; and (3) the social level: the characteristics of larger social systems, which include social, economic, political and cultural forces.

Table 1 contains a summary of risk factors forhomelessness in the U.S. at the individual, institutional and social levels. Importantly, homeless episodes result from a combination of factors that accumulate over the lifecourse: Individual vulnerabilities, taken within the context of institutional experiences and the social environment,contribute greatly to the complexity of the problem of homelessness, particularly when it comes to predicting who is most likely to become homeless in the first place [31]. In fact, it may be the conjunction that counts; in other words, being the wrong person in the wrong place at the wrong time [32]. A concerted effort is needed to prevent homelessness before it occurs by addressing root causes in the general social environment. Additionally, preventing homelessness among identified high-risk groups, such as persons with mental health, substance abuse or trauma histories, require targeted interventions that go beyond what is done to improve the social environment for the general population. Addressing these multiple levels from a prevention-oriented approach, rather than a crisis management and rehabilitative treatment approach, requires a comprehensive conceptualization of prevention that addresses the fundamental contextual and individual causes of homelessness.

OVERVIEW OF CONCEPTUAL PREVENTION FRAMEWORKS
Preventing homelessness requires an appropriate framework to guide the development of prevention
Table 1. Summary of Empirically Identified Risk Factors for Homelessness

(See?  I told you you'd be hooked!)

the state of Tennessee has come down hard on the VSO (Veteran Services Organization), ordering the group to pay $50,000 in penalties for 10 separate violations of the state's Charitable Solicitations Act.

Nothing worse to me than those who prey on the weak or those who manipulate the generosity, compassion and kindness of humans to exploit them.  Glad to see that the initial efforts by Operation Stand Down Nashville to expose this group as a bunch of phony thiefs has met with such great success, and I'm hoping this is just the first domino to fall for them, as they've been stealing the money honest, caring people have been misled into thinking was going to vets for a lonnnngggg time now, in many many states.

A big thanks to channel 5 and everyone else who worked to expose these creeps, as well as Todd Kelley, director of Tennessee's Charitable Solicitations Division, who put some teeth into the demand to stop stealing from the public under the guise of assisting veterans.

If you happen to see these clowns out collecting, please call the State of TN Solicitations Division at (615) 741-2555.

Tennessee's Charitable Solicitations DivisionState Cracks Down on Veterans Fundraiser Group

Posted: Jul 26, 2010 6:41 PM CDT

• Read the state's letter penalty assessment letter (.pdf)

• NewsChannel 5 Investigates Veterans Fundraiser Group

• State Asks Veterans Fundraising Group to Turn Over Records

By Jennifer Kraus
Consumer Investigator

NewsChannel 5 Investigates first exposed the practices of a group claiming to raise money for veterans. Now, that group has been ordered to stop collecting donations in Tennessee and has been hit with a hefty fine by the state.

It's the latest fallout from our undercover investigation.

Back in February, NewsChannel 5 Investigates first exposed how the Veterans Support Organization was collecting money in Middle Tennessee. And, we found that what our undercover crews were told by the men dressed in fatigues wasn't always true.

One man collecting donations told us, "We can help get a homeless or needy veteran off the street and into our shelter."

That same man also told us he was out there volunteering his time, even though NewsChannel 5 Investigates later discovered he was, in fact, getting paid.

"We believe that they were making false statements to the public about what they're using contributions for," said Todd Kelley, director of Tennessee's Charitable Solicitations Division.

Now, the state of Tennessee has come down hard on the VSO, ordering the group to pay $50,000 in penalties for 10 separate violations of the state's Charitable Solicitations Act.

Back in February, Hank Edney, the head of the Tennessee VSO office at the time, assured NewsChannel 5 Investigates, "All of the funding raised here will stay in Tennessee."

The group's own brochures made similar claims.

Now, the state is going after the group for falsely claiming that the VSO provides veterans in Tennessee with things like furnished apartments, permanent housing, and employment assistance and that it has a "professional partnership with the VA Health Care System."

According to state regulators, that is all untrue.

"I think it's quite serious," Todd Kelley said. "I mean, anytime a charitable organization misrepresents itself when appealing to the public for contributions, we take that very seriously."

After our investigation, the group's national leaders insisted that what we uncovered were a few isolated incidents. They even put out a press release insisting that the individuals soliciting donations that we talked with shouldn't be believed because they suffered from "Post Traumatic Stress Disorder and other mental health disabilities."

But the man who regulates charities in Tennessee said his office's investigation found false claims also coming from the group's higher-ups.

"In this case, these printed materials were clearly coming from the organization," Kelley explained.

Since moving into Tennessee in January, the VSO has collected tens of thousands of dollars in the name of veterans. State regulators say it's important for folks to ask questions before they give to find out exactly who they're giving to and what the money will be used for.

Kelley added, "And, this (the VSO) is proof positive of why they need to do that."

A spokesperson for the VSO told NewsChannel 5 Investigates that the group plans to appeal the violations because she said they do provide the services. However, they're available only in Florida.

She insisted the VSO never claimed to offer them here. The state disagreed and said the letter spelling out the violations speaks for itself.

The Veterans Support Organization is also being fined because it never registered with the state to raise money here, even after being told by regulators that they had to do so before collecting any more donations.

E-mail: jkraus@newschannel5.com

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Heat Index Could Hit 110 Degrees Today

Oh my GAWD it's freakin hot, even for the South!  The only other time I've had to deal with this kind of heat was when I spent time in Death Valley, California!

It's so hot that when I stepped off the porch and into the direct sun yesterday, the temperature had weight to it and you could feel the heat pressing on you; and I mean pressing on you, like it had some physical presence against your body.

Folks on the street are staggering around, looking for respite in damned near any place they can find it, and many of us who normally try to spend time on the streets helping others are finding any excuse we can not to go out in it.  This is a rare change because most of the time, folks are out in every kind of weather, but I'm telling you, this heat is beyond ridiculous.

I submitted a piece to the homelessness resource center recently that should come out there soon and I'll share it here, because it deals with outreach in the heat and may help some of you in your efforts.

Beating the Heat on the Street

As an outreach worker and a formerly homeless person in recovery, I know firsthand the impact hot summer days can have on those of us who must survive almost continual immersion in the natural elements. Much has been written on the clinical symptoms of hyperthermia and the signs and symptoms of exposure to extraordinarily hot summer days are important to know and recognize.

Heat-related illness occurs when a person’s body is unable to compensate for the increase in temperature and properly cool off. Cooling occurs normally by sweating and evaporation but in some situations an individual’s perspiring is simply not enough to get the job of cooling the body done. When this occurs, a person's internal temperature can quickly rise into the danger zone and if left unchecked, the high body temperature may damage the brain or other vital organ and could result in death. Joseph Rampulla explains that “heat waves account for more deaths than all other natural disasters combined in the USA (2004). He reminds us that the poor, elderly, children and those individuals who isolate themselves are both at very high risk and are “disproportionately affected” by extreme heat.

The Center for Disease Control (CDC) states that “Extreme heat is marked by temperatures that stay 10° or more above the average high for a region over a period of weeks” and provides the following information to recognize heat related emergencies:

• Heat cramps are painful spasms of the leg or stomach muscles that may be accompanied by heavy sweating. They do not require medical attention, but the person should stop all activity, sit quietly in a cool place, and drink water, juice, or a sports drink.

• Heat exhaustion is marked by extreme fatigue, heavy sweating, thirst, headache, dizziness, fast and shallow breathing, nausea and vomiting, pale and moist skin, and a fast, weak pulse. If untreated, the symptoms may progress to heat stroke.12,14 Cooling measures may include rest in an air conditioned environment; light weight clothing; cool, nonalcoholic beverages; and a cool shower or bath.

• Heat stroke is a life-threatening hyperthermic condition caused by breakdown of the body’s thermoregulation. The skin no longer sweats and becomes red, dry, and very hot. Body temperature is above 103°F and can rise rapidly to 106° F in as little as 15 minutes.14 Chest pain, shortness or shallowness of breath, and abdominal pain may be present along with confusion, anxiety, a rapid pulse, and throbbing headache. Until emergency medical care arrives, caregivers should start to cool the person rapidly with whatever methods are available: remove extra layers of clothing, fan, wrap in a wet sheet, sponge with any cool liquids, or spray with cool water from a garden hose.

While the medical aspects of over-exposure to heat are certainly important to understand, they are not the only issues individuals face when the mercury rises. Sweltering days may cause significant difficulties in the daily routine of individuals while increasing overall risk factors to those who must endure them. My own anecdotal street experience in dealing with the heat on the street has found that when the weather turns oven-hot for days at a time, cities get even hotter, thanks to heat-absorbing properties of asphalt and concrete, creating the “urban heat phenomenon” (Rampulla, 2004).

People experiencing homelessness are already under significant stress from difficult living conditions and adding unbearable heat for long periods can reduce coping mechanisms; tempers may increase as patience and tolerance can shorten. Several other troublesome issues arise; insomnia increases among many people experiencing homelessness due to intolerable sleeping conditions; the heat increases the risk of food spoilage and resultant illnesses for those without access to refrigeration; and hot temperatures also causes some to take increased risks in order to beat the blazing heat by swimming in dangerous and/or polluted waters, trespassing to access cool areas, drinking alcohol more heavily than normal, using drugs to escape the misery, etc. Alcohol and coffee are diuretics which can quickly deplete the body of available fluids, while certain drugs, especially amphetamines or cocaine, create hyperthermic responses in the body under normal conditions; using speed, crack or cocaine during heat waves can spell disaster for the individual.

I approach outreach differently during very hot days. If one is available, I try to use a large air conditioned van and fill several coolers with ice and bottled water. I make my rounds around the city and offer “cool seats” inside the van when I encounter people on the street. I have a small dvd player and a selection of comedies that folks can watch as they take 30 minutes to sit in a cool environment and rehydrate themselves. I also provide free “shuttle service” to the local libraries and day shelters so folks don’t have to walk to “cooling centers” in the heat. I try to regularly visit those people I know to have serious and/or chronic health issues that make them more susceptible to the heat. Finally, I purchase extra daily bus passes and hand them out so individuals can escape the heat by riding air conditioned public transportation.

Summertime brings with it additional dangers and problems for those on the streets, but it also brings new opportunities for outreach and engagement as well. A kind face, a cool seat, a short ride, a bottle of iced water, and a bus pass will be remembered by those you’ve helped for a long time to come, and you may just save a life in the process.

CDC. (2007). Emergency Preparedness & Response. (2007). Centers for Disease Control
and Prevention. http://www.bt.cdc.gov/disasters/extremeheat/heat-guide.asp

Rampulla J. (2004). Hyperthermia & Heat Stoke: Heat-Related Conditions, In The Health
Care of Homeless Persons: A Manual of Communicable Diseases and Common Problems in
Shelters and on the Streets, Boston Health Care for the Homeless Program.
http://www.bhchp.org/BHCHP%20manual/pdf_files/ Part2_PDF/Hyperthermia.pdf

.

Training w NIDA Disaster Responders Today

Several months ago, I was approached by Dr. Bennett Fletcher who works for the National Institute on Drug Abuse (NIDA).  Some quick background: NIDA established the Criminal Justice-Drug Abuse Treatment Studies (CJ-DATS) project in 2002 to reduce substance abuse and recidivism among offenders following their release from jail or prison.

"Dr. Bennett Fletcher serves as CJ-DATS program scientist and provides NIDA input to the network's planning and decision-making. According to Dr. Fletcher, 'As many as half of the individuals serving sentences in the Nation's jails and prisons have drug problems. The transition from detention or incarceration is a period of high risk for relapse to drug use, acquisition and transmission of infectious diseases, and drug-related recidivism. In its first 5 years, CJ-DATS identified a range of effective practices to reduce these risks.'"

  Dr. Fletcher is no slouch when it comes to research and effective policy formation, and one of the things he is interested in addressing is the fact that that the last several major disasters that occurred in our country, especially Katrina, brought with them an interesting sub-population that experienced displacement; opiate addicts.

Now I'm sure this is nothing new; disasters have happened and displaced folks for as long as humans have wandered nekkid and hungry on the earth, and opium/opiates and those who've used the drug excessively have been suffering withdrawals when their stash ran out or they were forced to leave their stash - and their connections - behind since the first person ate a poppy and fell in love with the buzz that followed.

The problem of course is that first responder disaster teams have no idea how to handle these kinds of folks, and frankly, most typical medical units aren't really equipped to address the issues related to withdrawals either, which, if one has  been using opiates, especially high quality, big gun junk like China White or the more prevalent and oh so popular Mexican Black Tar heroin (that's the one that grabbed me by the short hairs and didn't let go for many many years), is going to be very bad indeed.

I've heard people who really have no idea tell me that withdrawing from heroin or opiates is like dealing with the flu. 

Yeah, right. 

Maybe if user was using low-grade peashooters like vicodin or codiene, I'd agree.  Or perhaps if the flu also brought with it Dante's nine circles of hell and a couple of dozen World of Warcraft Ogres who repeatedly smashed your body with wood mallets, I'd concur. 

But it doesn't and it's NOT at all like the goddam flu because I've had the real flu at least a couple of times in my life, and I've been "dopesick" dozens of times and I'm here to tell you, unequivocally and with absolute certainty that withdrawing from a serious opiate addiction is definitely not like the flu, got it? 

What makes it different from the flu, and any junkie will tell you this, isn't the severity of the body aches, the diarrhea and vomiting, the wickedly disgusting potency of usually benign and familiar smells, the vicious "running legs" and insomnia, the sweats, chills and shakes, although they are all doubly bad enough to move a withdrawal far outside the realm of flu illness. 

It's the mindfuck that moves it into a hellish world all its own....

I was withdrawing one time in a small northeastern California town and it was definitely a very bad kick.  I had been using heavily and daily for many months when I ran out of  chiva (street slang for black tar heroin).  The first 24 hours were merely  agonizingly miserable, but as I moved into the height of the withdrawal, the real fun began. 

I was laying on the floor of my bedroom because the smell of the sweaty, filthy sheets made me vomit nonstop.  I had a fan on to blow-dry the sweat pouring off my body and as I lay there, the fan began to make stange woowooowooo sounds, long, drawn out, like an engine slowly winding up, then down.  I opened my eyes and was suddenly in a very demonic place, and I'm definitely not one to bring religion or religious images into the forefront of my thinking.  I knew I was still in that bedroom, but the room itself had transformed into a large, greyish green area made up of moldy large blocks and had, at bizarre, skewed angles, these big iron doors like castle doors; rounded at the top, with what appeared to be big rivets going up one side, across the top and then dropping down to the floor on the other side. 

As I lay there, with this damned fan woowooing me into psychosis, my mind's eye traveled to the first door and I heard a loud, clanging bell, like a very large church steeple bell, that clanged and clanged.  As the bell clanged, I heard a very deep and dark, sort of Vincent Price voice call out: "Hear ye, Hear ye, all who enter here enter the gates of hell!"  The door then flew open under this truly evil and maniacal laughter, exposing hundreds of living dead people all in various stages of using; some fixing their dope, some injecting themselves, some helping others, and all of them looking at me with this horrid grin while beckoning me to come join them.

I have no idea how long it lasted but I was forced somehow to visit every door, and in each of those rooms I was waved in by these....damned demons, all of whom could have taken a role in a zombie flick without any need for makeup or wardrobe.  

Through it all I knew it wasn't really happening, but it was so powerful, so real and so terrifying that it caused a 'flashbulb" moment for me and it has been forever burned into my memory in all its detail so much so that I can clearly see it in my mind as I write this.

Granted, that was by far the worst mindfuck I've ever experienced, but the manipulation of one's thought processes and emotions while undergoing a strong opiate withdrawal is a very powerful and mentally painful separator from the flu.

The other aspect of this is the desperation in which one operates as they struggle to "get well" and search for dope.  I would drive 100 mile an hour down Highway 70 (the Feather River bypass), which is a twisty canyon road following the Feather River, hauling ass to get to a connection in Marysville or Oroville and not caring whether I lived or died in a crash on the way.  I surely ran people off the road and often was driving while puking and sick sick sick as I drove maniacally down that highway in a desperate drug seeking run.

I know too how someone could rob a store or a person at gunpoint, although thank the Gods I never stooped to that level, but the fear of that sick is so strong that some people are driven to actions they'd never ever consider under any other circumstances. 

So I will spend today enlightening "first responders" to the challenges and pitfalls in dealing with displaced opiate addicts under the tutelage and supervison of Dr. Fletcher.  I'm excited that I can turn the worst part of my life's history into something positive and helpful for others, and I owe a huge thank you to BigWillyC for referring Dr. Fletcher to me.  Ought to be a real hoot today....

New Regulations on PTSD Claims

New Regulations on PTSD Claims

Background:

On Monday, July 12, 2010, the Department of Veterans Affairs (VA) is scheduled to publish a final regulation that will make access to care and the claims process easier for Veterans seeking compensation for Post-Traumatic Stress Disorder (PTSD).  The rule reduces the evidence needed if the PTSD stressor claimed by a Veteran is related to fear of hostile military or terrorist activity and is consistent with the places, types, and circumstances of the Veteran’s service. 

PTSD is a recognized anxiety disorder that can develop from seeing or experiencing an event that involves actual or threatened death or serious injury to which a person responds with intense fear, helplessness or horror, and is not uncommon among war Veterans. 

Under the new rule, VA will not require corroboration of a PTSD stressor related to fear of hostile military or terrorist activity if a VA psychiatrist or psychologist confirms that the stressful experience recalled by a Veteran adequately supports a diagnosis of PTSD and the Veteran's symptoms are related to the claimed stressor.

Previously, VA required non-combat Veterans to corroborate the fact that they experienced a PTSD stressor related to hostile military activity.  This final rule simplifies the development that is required for these cases.

VA expects this rulemaking to decrease the time it takes VA to decide disability claims and access to health care, falling under the revised criteria and for Veterans to access health care.  More than 400,000 Veterans currently receiving compensation benefits are service connected for PTSD.  If service connection for PTSD is established under the new rule, a Veteran disabled by PTSD will be entitled to disability compensation, which is a tax-free benefit paid to a Veteran for disabilities that are a result of -- or made worse by -- injuries or diseases associated with active service.

           

Quick Facts:

·         The new rule will simplify and streamline the processing of PTSD claims, reducing the time and frustration traditionally involved when Veterans apply for disability compensation for PTSD and access for mental health care.

·         Veterans who do not otherwise meet eligibility requirements for enrollment in the VA health care system cannot receive mental health treatment at a VA facility without a disability rating from VA.

·         This new rule is for Veterans of any era.

·         This decision is consistent with recent Institute of Medicine studies of scientific data.

·         The new rule will apply to claims:

o   received by VA on or after July 12, 2010;

o   received before July 12, 2010 but not yet decided by a VA regional office;

o   appealed to the Board of Veterans' Appeals on or after July 12, 2010;

o   appealed to the Board before July 12, 2010, but not yet decided by the Board; and

o   pending before VA on or after July 12, 2010, because the Court of Appeals for Veterans Claims vacated a Board decision and remanded for re-adjudication.

·         Not all combat wounds are visible.  For decades, VA has led the health-care community in treating and researching the psychological wounds of war, especially PTSD.

·         Since the start of combat in Iraq and Afghanistan, VA has dramatically expanded the number of its mental health professionals to care for returning Veterans, including 1,000 just last year alone. 

·         VA will continue its world-class research program and its aggressive outreach to returning Veterans.  The Department is committed to continuing to improve its processes to meet the needs of our newest generation of heroes.

·         VA will continue to verify war deployments with the Department of Defense (DoD) to protect our Veterans from the backlash against any attempts at fraud.

·         VA is the largest integrated health care system in the Nation and consistently ranks at the top, or near the top for quality and safety by various sources to include seven US News  World Reports’ “Top US hospitals,” and HHS’s & Medicare Hospital Comparison metrics.

QUESTIONS AND ANSWERS

For VA Final Rule AN 32

“Stressor Determinations for Posttraumatic Stress Disorder”

1.      What is Post-Traumatic Stress Disorder (PTSD)?

Post Traumatic Stress Disorder (PTSD) is a condition resulting from exposure to direct or indirect threat of death, serious injury or a physical threat.  The events that can cause PTSD are called "stressors” and may include natural disasters, accidents or deliberate man-made events/disasters, including war.  Symptoms of PTSD can include recurrent thoughts of a traumatic event, reduced involvement in work or outside interests, emotional numbing, hyper-alertness, anxiety and irritability.  The disorder can be more severe and longer lasting when the stress is human initiated action (example: war, rape, terrorism).

2.      What does this final regulation do?

This final regulation liberalizes the evidentiary standard for Veterans claiming service connection for post traumatic stress disorder (PTSD).  Under current regulations governing PTSD claims, unless the Veteran is a combat Veteran, VA adjudicators are typically required to undertake extensive record development to corroborate whether a Veteran actually experienced the claimed in-service stressor.  This final rulemaking will simplify and improve the PTSD claims adjudication process by eliminating this time-consuming requirement where the claimed stressor is related to “fear of hostile military or terrorist activity,” is consistent with the places, types, and circumstances of their service, and a VA psychiatrist or psychologist, or contract psychiatrist or psychologist confirms that the claimed stressor is adequate to support a diagnosis of PTSD. 

3.      What types of claims for VA benefits does the final regulation affect?

The final regulation will benefit Veterans, regardless of their period of service.  It applies to claims for PTSD service connection filed on or after the final regulation’s effective date, and to those claims that are considered on the merits at a VA Regional Office or the Board of Veterans’ Appeals on or after the effective date of the rule.  

4.      Why is this final regulation necessary?

The final regulation is necessary to make VA’s adjudication of PTSD claims both more timely and consistent with the current medical science.  

 

5.      How does this final regulation help Veterans?

The final regulation will simplify and streamline the processing of PTSD claims, which will result in Veterans receiving more timely decisions.   A Veteran will be able to establish the occurrence of an in-service stressor through his or her own testimony, provided that:  (1) the Veteran is diagnosed with PTSD; (2) a VA psychiatrist or psychologist, or a psychiatrist or psychologist with whom VA has contracted confirms that the claimed stressor is adequate to support a PTSD diagnosis; (3) the Veteran's symptoms are related to the claimed stressor; and (4) the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service and the record provides no clear and convincing evidence to the contrary.  This will eliminate the requirement for VA to search for records, to verify stressor accounts, which is often a very involved and protracted process.  As a result, the time required to adjudicate a PTSD compensation claim in accordance with the law will be significantly reduced. 

5.  How does VA plan to monitor the need for examiners in various regions of the country, and how does VA plan to respond if is determined that more examiners are needed in a particular region?

The Veterans Health Administration (VHA) has written in to the FY11-13 Operating Plan the need for additional staff to support doing adequate, timely exams.  VHA proposes: “A8. Increase mental health field staff to address the increase in C&P examinations and develop monitoring system to ensure clinical delivery of mental health services does not decrease in VHA.“  Specifically, VHA has requested 125 clinicians for FY11 with additional 63 staff in FY12 if the need exists. If the Operating Plan and the proposed budget are approved, VA proposes asking the Veterans Integrated Service Networks (VISNs) to develop plans for distributing the funds in order to ensure adequate coverage at sites based on number of claims being processed; the VISNs are well positioned to determine these regional needs.

6.  How does the regulatory revision affect PTSD service connection claims where an in-service diagnosis of PTSD has been rendered?

The new regulation does not apply to the adjudication of cases where PTSD has been initially diagnosed in service.  Rather, under another VA rule, 38 CFR § 3.304(f)(1), if a Veteran is diagnosed with posttraumatic stress disorder during service and the claimed stressor is related to that service, in the absence of clear and convincing evidence to the contrary, and provided that the claimed stressor is consistent with the circumstances, conditions, or hardships of the Veteran's service, the Veteran's lay testimony alone may establish the occurrence of the claimed in-service stressor.

7.  Is the new regulation applicable only if the Veteran's statements relate to combat or POW service?

No.  The rule states that the stressor must be related to a “fear of hostile military or terrorist activity,” and the claimed stressor must be “consistent with the places, types, and circumstances of the veteran’s service.” 

8.  What circumstances will still require stressor verification through DoD’s Joint Services Records Research Center (JSRRC) , VBA’s Compensation &Pension  Service (C&P Service), or other entity if a Veteran claims that his or her stressor is related to a fear of hostile or terrorist activity?

The regulatory revision will greatly lessen the need for undertaking development to verify Veterans’ accounts of in-service stressors.  Now, stressor development may only need to be conducted if a review of the available record, such as the Veteran’s service personnel and/or treatment records, is inadequate to determine that the claimed stressor is “consistent with the places, types and circumstances of the veteran’s service.”  In such circumstances, the Veterans Service Representative (VSR) will determine on a case-by-case basis what development should be undertaken. 

However, it is anticipated that in the overwhelming majority of cases adjudicated under the new version of § 3.304(f), a simple review of the Veteran’s service treatment and/or personnel records will be sufficient to determine if the claimed stressor is consistent with the places, types, and circumstances of the Veteran’s service.  We also believe that, in some cases, a Veteran’s separation document, DD-Form 214, alone may enable an adjudicator to make such a determination. 

9.  As the regulatory revision seems to require an enhanced role for the examining VA mental health professional, whose role is it to determine whether the claimed stressor is consistent with the Veteran’s service? 

VA adjudicators, not the examining psychiatrist or psychologist, will decide whether the claimed stressor is consistent with the Veteran’s service. 

10.  Is a Veteran's testimony about “fear of hostile military or terrorist activity” alone sufficient to establish a stressor?

Yes, if the other requirements of the regulation are satisfied, i.e., a VA psychiatrist or psychologist confirms that the claimed stressor is adequate to support a PTSD diagnosis and that the Veteran's symptoms are related to the claimed stressor, and the stressor is consistent with the “places, types, and circumstances of the Veteran’s service.” 

11.  Are the stressors accepted as adequate for establishing service connection under new § 3.304(f)(3) limited to those specifically identified in the new regulation?

No.  The examples given in the revised regulation do not represent an exclusive list in view of the use of the modifying phrase “such as” that precedes the listed examples.  Any event or circumstance that involves actual or threatened death or serious injury, or a threat to the physical integrity of the Veteran or others, would qualify as a stressor under new § 3.304(f)(3). 

12.  How will the Veterans Health Administration (VHA) work with Veterans Benefits Administration (VBA) on the new regulation?

VHA was actively involved in discussion with VBA of the new regulation and fully supports the new regulation.

• The new regulation will provide fair evaluation for Veterans whose military records have been damaged or destroyed, or for whom no definitive reports of combat action appeared in their military records, even though they can report such actions and it is reasonable to believe that these occurred, given the time and place of service.
• This will be especially beneficial to women Veterans, whose records do not specify that they had combat assignments, even though their roles in the military placed them at risk of hostile military or terrorist activity.

• This means that more Veterans will become eligible for VA care and thus be able to receive VA care for mental illness related to their military service, as well as receiving full holistic health care.VHA will work actively with VBA on implementing the regulation. VHA staff’s main role is as clinicians conducting C&P interviews to establish diagnoses and obtain other information to be used by VBA raters to determine the outcome of claims. 
• The new regulation will not change the diagnostic elements of the C&P interview, but may change what additional data are collected for use by VBA raters. 

OMG! I Bought a House!

I've lived in a lot of places of the past 50 years, from the disgusting dirt floor basement of a house full of hookers in Lansing Michigan to a nasty trailer in Port Orange Florida that was literally crawling with roaches and palmetto bugs.  I wintered in the Sierra Nevada mountains in a handbuilt lodgepole Teepee, then moved to a Chinese Cook's cabin on a ranch under Spanish Peak in Meadow Valley, California.  I've lived right on the Feather River in a dot of a town in Northeastern California and grew more pot in the spare bedrooms than most folks could smoke in three lifetimes.  I've lived in the upper peninsula of Michigan on the shore of Lake Superior, ran nekkid with my lovely wife the back yard desert of my home in the Washoe mountain range of Nevada, and lived next to a guy in Philadelphia who told me he was going to introduce me to "Pink" of Pink Floyd (I'm still waiting to meet ol Pink....).  I've hunkered down with junkies in abandoned flats from Detroit to San Francisco and the single common theme for every one of those places I've lived in the past 50 years - when I wasn't wandering streets, alleys and towns homeless - is that I'd never be able to own any one of them.


Until now.

After 12 years of meticulous attention to my credit, I had a score high enough to qualify for a THDA first time homebuyer's loan.  I got prequalified and made an offer on a little house in the Mt. Juliet area yesterday.

Today the owner accepted my offer.

I'm thrilled....

But I think you all need to excuse me while I go throw up now....

More than 2 million workers who have been laid off for long stretches could get their unemployment benefits restored as early as next week

I know why it takes elections to generate enough interest in those suffering along through "unenjoyment " to restore or extend their benefits; it's all about trying to get votes, we all know that.

What I don't know or understand is how anyone can argue against providing unemployment benefits to people who have lost their jobs and are actively seeking alternative employment opportunities.

The sheer idiocy of comments like the one GOP Sen. Kyl tossed onto the Senate floor during a debate - "Unemployment Benefits Make People Not Want To Get A Job" - gives me at least an inkling into the stinkling thinkling some have when it comes to this issue, but in every single case I've had in front of me over the past year, not one of those persons was making a go of it on their unemployment bennies when compared to what their salaries were when they were working full time.  In fact, the very vast majority of them were in my office with eviction and cutoff notices, hoping we'd be able to provide at least a little relief as they downsized their lives and eliminated every budget item that wasn't an absolute necessity in their lives.

I was discussing this issue with a colleague the other day and the conversation eventually settled on the idea that we will never understand this kind of thinking, since it defies the rational, logical mind, especially if one has had the opportunity to work with people who are barely surviving on their benefits and who are desperately trying to find work before the money runs out completely.  It's akin to the rational mind trying to understand what motivates a child molester, a rapist, an arsonist, a murderer, it's so out of the scope of logic, compassion and respect for one's fellow human neighbors in this world that it defies the ability to grasp it enough to create a rationalization.

I don't mean to call Senatory Kyl any of these things and I certainly don't intend to suggest his statement is on par with the heinousness of these acts.  I'm merely arguing here that it's as impossible for me to understand his thought process here as it is for me to understand why someone would commit a serious crime against another human being.

And what's even scarier to me is the fact that it's not just Sen Kyl who thinks like this, but apparently so too do enough Americans - my fellow countrymen and women who most certainly have in at least some way been negatively impacted by the current economic situation in the United States - to get this guy elected into political office.

I guess ultimately this bring me to the conclusion that ignorance breeds contempt and at times, gross incompetence and stupidity in terms of actions either taken or prohibited.  That we need education and awareness on a scale so large that it reaches the entire nation is a task so daunting to lil ol me that I can barely fathom that, either.  But rather than giving up and sticking my gnarled old head in the sand, like so many of us do on issues like this, I'm saying something about it.  Raising awareness, dontchakno, because I believe that even if we've got to do this - raise awareness and understanding - one person at a time, it's too important to ignore because so many are counting on us to provide a voice that's been silenced by poverty....

Senate Close to Restoring Jobless Benefits As Midterm Election Approaches

Friday, July 16, 2010
By Stephen Ohlemacher, Associated Press

Washington (AP) - More than 2 million workers who have been laid off for long stretches could get their unemployment benefits restored as early as next week.

The Senate plans to take up a measure Tuesday to restore the extended benefits, right after a new Democratic senator from West Virginia is sworn in, Senate Majority Leader Harry Reid said Thursday.

With the death of Sen. Robert Byrd, Senate Democrats had been a vote short of the 60 needed to overcome a GOP filibuster. West Virginia Gov. Joe Manchin has said he could name a temporary replacement to fill Byrd's seat as early as Friday.

The House already has passed a bill to extend the benefits through November, at a cost of about $34 billion. The money would be borrowed, adding to the national debt.

About 2.5 million people have lost their benefits since the last extension ran out at the end of May. The bill would add up to 73 weeks of extra benefits, paid for by the federal government, on top of the 26 weeks typically provided by states.

Reid, D-Nev., said Byrd's replacement will be sworn in Tuesday afternoon, and a bill to extend the jobless benefits will be up for a vote immediately afterward.

Lawmakers have been sparring for weeks over extending the benefits. Some Democrats have argued that lawmakers have a moral obligation to extend the benefits while the unemployment rate hovers above 9 percent. Many Democrats also see the benefits as insurance against the economy sliding back into recession because laid off workers typically spend their payments quickly, stimulating the economy.

Republicans, tapping into voter anger about the growing national debt, said they would support extending the benefits if the bill was paid for. They have proposed using unspent money from President Barack Obama's massive 2009 economic recovery package, a plan Democrats oppose

Man Hit Walking on I65 Under Overpass last Night

Channel 5 news is reporting that a "homeless man" was struck by several vehicles as he attempted to cross I-65 under the Rosa Parks bridge.

The reporters were wondering why someone would be on the interstate after midnight and I instantly flashed on the two gentlemen I picked up a couple of days ago, drenched in sweat and about to pass out from heat exhaustion.  Yesterday's weather was the same, if not worse, and even my oldtimer, Kuma, who normally loves loves loves the heat on his ol bones, just sits inside the on an ac vent and looks away when I try to coax him outside to do his bidness.  He's no fool.

So here's a very plausible scenario: Man has some appointment to make over in Metro Center, which happens to house a number of government agencies, as well as the Mental Health Cooperative.  Man makes it over there during business hours but doesn't want to have to deal with midday furnace temperatures.  Man waits until it's dark to walk anywhere.  Man avoids bridge due to chance encounter with police vehicle and decides to cross freeway instead.  Man may or may not have had a few beers, bottles of "wash" or other intoxicating substance.  Man misjudges speed of oncoming vehicles and gets smucked.  End of story.

See?  If ya just think about it for a sec, it's pretty simple to consider how the gentleman wound up on the freeway around midnight on one of the hottest days of the summer so far.

Homelessness kills in so many ways.....

&#%@^! Heat Is Really Getting OLD

I dread summer in the South.  It's hotter than hell -every damned day - the humidity hangs on you like a cheap suit, and nighttime brings little to no relief.  People sweat, stink, their hair frizzes, and they usually glisten like they've been rubbed down with....well, glycerin.  And these are people who are inside under air conditioning!

For folks on the street, in the camps and under bridges, it's intolerable, not to mention miserable.  I've written a piece that should come out in the Homelessness Resource Center this week on how I do outreach during the summer months so I'll post that here when it appears online there; don't want to steal the thunder from my company's site, but I'm writing this today because of what happened yesterday, which weather-wise was as freakin miserable as it appears it's going to be again today. Sigh.

Around 2pm yesterday I had to run to the bank to deposit a personal check from my dear friend and outreach mentee Denis Huey-Duey.   Denis is facilitating the purchase of my first home ever by helping me pay off a motorsickle in order to drop my debt ratio below the point at which I'm eligible for the good ol THDA loan.  Denis came into a small bit of cashola recently - nothing to retire on, mind you, but enough to help out a friend for a short minute, and he did just that so that I was able to put an offer in on a home last night.  More on this in another post because it's definitely worth writing about, given that I didn't really even think I'd live to 50, let alone ever have a credit score good enough to purchase a house!  But I digress bigtime, as usual....

So I am driving out of the parking lot at work and walking towards me I see two gentlemen I've known for years and have assisted into housing.  They have been living in an apartment for at least a year now, and have been managing their affairs and living arrangements quite well; they just needed a hand up into a place and they could handle their business from that point, and they did so quite admirably.

As they neared me, I noticed that both of them were sweating profusely and one looked very pale.  I immediately asked them to sit down in the AC of the van and as "Bob" reached for the door handle, he damn near passed out.  His friend was able to help him into the vehicle and transport him the couple of additional miles they would have had to hoof had I not crossed their path at that moment.

I drove them to the door of their highrise complex and they thanked me like I'd delivered them to the gate of Heaven, and I drove off to finish what I'd started, but it got me thinking again about how damned miserable hot weather can be for folks on the street, especially for those who can't escape it in the air conditioned confines of an apartment, library, shopping mall, or other place of respite.

When I was a paramedic, it was common knowledge among us all that summertime brought with it an increase in assault, murder and domestic violence responses.  I doubt that has changed much and in fact, I'd venture to argue that the call volumes of police and paramedics have probably increased, especially given the current state of our economy, the difficulty the impoverished have in making ends meet and the agonizing discontentment of so many who view their situation as hopeless and permanent.   

Tempers flare and what little patience people may have as a direct result of the intense frustration boiling just below the surface 24/7 evaporates directly into the sweat on their stinking bodies, staining their clothes, curling their hair and pissing people off even further. 

It's no wonder people look for ways to escape.  It's now been a dozen years since I've had to cope with the street, and for that I'm more thankful than you can imagine.  Now I get grumpy when I know I've got to go out and mow the lawn in the heat.  I can tell you right now that were I forced to walk across town for some soup kitchen grub, then walk who knows how far to find a place hidden enough  for me to try and sleep in 90 degree heat, I'd be an ornery sob.   Add to that the hassles of trying to find bathrooms, cops harassing me every time I lingered anywhere in public, the stares, glares and nasty comments from passerby, the shooing of business owners when I tried to enter the store, the lack of enough money to even buy a cold drink, and the fact that the filthy, stinking clothes on my back were what I had to wear for the next couple of weeks,  I'd be a ticking time bomb. 

So the next time you see someone shuffling along under the glare of a furnace hot sun, think for a minute what it'd be like to walk not just a mile, but a damned eternity in those shoes.  I can just about guarantee you that the person you see is wondering whether or not there's ever going to be a reason to continue living....

Homeless Prevention Rapid Rehousing Program Quarterly Report

The HPRP program is probably one the best resources to come along for folks I've ever seen.  It's definitely not perfect and there is a lot more needed, but HPRP's flexibility has saved thousands from being tossed into the street.....

Quarterly Leadership Council HPRP Report: January - March 2010

Report | 31 May 2010 Author: National Alliance to End Homelessness Files: PDF | 150 KB | 2 pages This report illustrates how 13 cities across the nation are implementing their Homelessness Prevention and Rapid Re-Housing Program (HPRP) programs. Data from the following 13 cities are included in this quarterly report: Chicago, IL; Columbus and Franklin County, OH, Denver, CO; Houston and Harris County, TX; Miami-Dade, FL; Minneapolis and Hennepin County, MN; New Orleans, LA; New York City, NY; Philadelphia, PA; Portland, OR; San Francisco, CA; Seattle, WA; Washington, DC. Leadership Council Communities and HPRP Homeless Population The homeless populations in the 13 Leadership Council cities in this report represent roughly 17 percent of the 2007 US homeless population. HPRP Allocation The $188M in programmatic HPRP funds allocated to Leadership Council cities is just under 14 percent of the entire program. Jobs Saved/Created (- 10 jobs created or saved) Approximately 680 full time equivalents (FTEs) were reported as created or saved for the quarter by Leadership Council cities. Program Emphasis - Prevention versus Rapid Re-housing Approximately two-thirds of the HPRP programmatic funding allocated to Leadership Council cities is allocated for prevention activities () with the remaining third allocated for rapid re-housing (). There is wide variation among communities. San Francisco, Miami, New Orleans, and New York heavily emphasize prevention while Columbus and Washington, DC focus on rapid re-housing. All (65%) Chicago (69%) Columbus (30%) Denver (40%) Houston (67%) Miami (71%) Minneapolis (60%)   New Orleans (70%)   New York (70%)   Philadelphia (54%)   Portland (65%)   San Francisco (85%)   Seattle (63%)   Washington (26%) Program Emphasis - Financial Assistance versus Housing Relocation The HPRP programs in the 13 Leadership Council cities are using most (56%) of their funding for direct financial assistance () and the remaining 44 percent on case management, outreach, and other housing relocation services (). New York is the only city using less than half of it's allocation on financial assistance. All (56%) Chicago (72%) Columbus (52%) Denver (75%) Houston (66%) Miami (77%) Minneapolis (62%) New Orleans (73%) New York (34%) Philadelphia (70%) Portland (75%) San Francisco (66%) Seattle (81%) Washington (66%) Program Progress - Persons served and money spent Approximately $16 million has been spent through March 2010 on homelessness prevention for 39,000 people and $5.5 million has been spent to rapidly re-house 23,000 people. While 13 percent of prevention funds and 8 percent of rapid re-housing funds have been used to date, several cities - Miami, Portland, Philadelphia, and New York - are using their funding at a much faster rate. Outcomes - Exit to permanent housing   Approximately 35,000 persons have exited rapid re-housing and prevention programs in the Leadership Council cities. Of the 15,869 that exited prevention programs, at least 11,754 (74%) exited to permanent housing. Of the 18,969 that have exited rapid re-housing programs, at least 18,462 (97%) exited to permanent housing.