Understanding Homeless Health Risks in Long Beach, CA

1. A Community Health Risk Assessment of Individuals Experiencing Homelessness in Long Beach, CA 90813 Zip Code Joana Valerie Garong Saguin, MSW California State University, Long Beach May 2018

2. Homelessness an ever growing social and economical issue surrounding not only the 90813 zip code of Long Beach, California, but the entire nation as well. • In the year 2016, the National Alliance To End Homelessness reported that there were an estimate of 544, 084 homeless people in the United States of America. • About 373,571 people were either living in shelter homes and transitional housing programs and approximately 176,357 were completely unsheltered, meaning they were living on the sidewalks, cars, abandoned buildings, or under bridges across the nation. • Individuals experiencing homelessness are susceptible to many medical health risks such as HIV/AIDS, hepatitis, pneumonia, tuberculosis, skin disorders, as well as psychiatric and mental health risks such as substance misuse, major depressive disorder, and psychotic disorders. They are also at risk for violence and other unpleasant circumstances being without stable housing. • On a nationwide level, homelessness has been reported to have declined, by almost 13% in the last 5 years with a 2.6% decrease between 2015 and 2016. However, on a statewide level, 22% of the nation’s homeless population or 118,142 individuals experiencing homelessness reside in California alone, making the state accountable for nearly one quarter of the homeless population in the United States. • In the City of Long Beach, homelessness has impacted every sector of the community. This issue has been the talk of the city and its residents and council members. Despite Long Beach City’s efforts to diminish the size of the homeless population in their community, increasingly people find themselves unable to afford housing and sustain employment. Thus, placing these individuals at high risk for acquiring diseases and mental illness.

3. Data on this thesis project were collected based on three risk factors which are; physical health, mental health, and housing needs in the city of Long Beach, as well as on a national and statewide level of sources when available. • “Between the years 2001 and 2007, the U.S. Department of Health and Human Services (DHHS) assembled a Homeless Policy Academy Initiative, in partnership with the U.S. Departments of Housing and Urban Development (HUD), Veterans Affairs, Labor, and Education, for the purpose of helping the state and local policymakers in improving access to mainstream services for individuals experiencing chronic homelessness”(Apicello, 2010 p. 42). • The National Alliance to End Homelessness (NAEH), a nonpartisan organization committed to preventing and ending homelessness in America, also released an extensive Ten-Year Plan to End Homelessness in 2001 to address the barriers that local authorities face. • In the City of Long Beach, homelessness is being addressed specifically through multiple interventions and prevention programs. It is one of the few cities in the State of California that has a bureau or division devoted strictly to the homeless population • The Continuum of Care (CoC) is composed of regional and local bodies that organize housing and funding services for homeless individuals and families. Their actions are aimed toward ending and preventing the ever-rising issue of homelessness in the greater Los Angeles County area. • Other programs designed to provide adequate support and services for the homeless population in the city of Long Beach are the multi-services center, a one-stop shop that serves as a primary hub for most needs, Housing First, Street Outreach Network, Storage of Belongings, a Homeward Bound Program, Shelter Beds, Winter Shelter, Rainy Day Shelter, and many more.

4. Multicultural Relevance • The demographic characteristics of the homeless population in the city of Long Beach by race are 58% White, 32% Black or African American, 4% Asian or Native Hawaiian or Other Pacific Islander, 4% Multiple Races or Other, and 2% American Indian or Alaska Native. Ethnicity is estimated as 76% Non-Hispanic/Non-Latino and 24% Hispanic/Latino. • The majority (65%) of the homeless population in Long Beach are adults between the ages of 18 and 54 years old and one quarter is 55 years and older. • Approximately 71% are male, 28% are female, and 1% identify as transgender. Social Work Relevance • To add to professional social worker's knowledge base a greater understanding of this vulnerable population’s physical health and mental health needs. • Understanding more about how to enhance overall human well-being and help meet the basic human needs of people is heavily supported by social work values of service, social justice, and dignity and worth of the person. • The importance of valuing and respecting a person regardless of socioeconomic status, ethnicity, cultural background, gender, and disability are key to effectively serving the chronically homeless population. • Advocating against the social injustice that this vulnerable population experience is also very important for the social work profession.

5. Data were collected based on the three domains associated with chronic homelessness: risk factors for physical health, mental health, and housing. • Information were utilized from statistical reports and government websites. Both current and archival quantitative data and statistics from public social indicators of local, state, and federal sources were used in order to assess for risks and examine the needs of the chronically homeless community in the City of Long Beach, CA. • It should be noted that the data were gathered specifically about the 90813 ZIP code of Long Beach whenever it was accessible and from data specific to individuals who are chronically homeless when available. However, in some instances, risk data were not available specifically to 90813 ZIP code, or to individuals who are chronically homeless; therefore, information was accumulated from other sources including relevant secondary data from Service Planning Area 8 of greater Los Angeles County and state and national sources. • Adaptation of the Catholic Health Association (CHA, 2013) model for community health assessment was used where relevant and feasible. • The federal and statewide sources of data were derived from the following: National Alliance to End Homelessness, U.S. Department of Housing and Urban Development (HUD) and the U.S. Census Bureau. • On a local level, data were collected from the City of Long Beach Point-in-Time Homeless Count conducted on January 26, 2017.

7. Data on three domains (physical health, mental health, and housing) measuring 16 risk factors were gathered from both archival data and major public sources. Data from Long Beach 90813 ZIP code were compared to data from Los Angeles County, state of California, and the United States. • The 16 risk factors are as follows: • Physical Health: Adults Delayed or Difficulty Obtaining Care, HIV/AIDS, Tuberculosis (TB), Age-Adjusted Hospitalization Rate due to Hepatitis, Uncontrolled Diabetes, and Adults with Health Insurance. • Mental Health: Mental Health Illness, Substance Use Disorder, Psychological Distress, Age-Adjusted ER Rate due to Alcohol Abuse, Age-Adjusted Hospitalization Rate due to Alcohol Abuse, • Housing: Median Property Value, Monthly Rent Cost, Unemployment rate, and Poverty rate. • Risk factors that are the utmost concerning for the community appeared to be difficulties in obtaining health care, infectious diseases, both ER and hospitalization rates due to alcohol abuse and high poverty rate.

8. Analysis • Descriptive statistics using percentages and number counts were used to present the results. The data were put into graphs to distinguish trends in the information provided. Data when available from the 90813 ZIP code were compared to the City of Long Beach, Los Angeles County, California, and national data to document the risk factors of homelessness in ZIP code 90813. • A 3% difference was considered significant. Summary of Findings • There were six risk factors assessed in the physical health domain: a) adults delayed or difficulty in obtaining care, b) HIV/AIDS, c) tuberculosis (TB), d) hepatitis, e) uncontrollable diabetes, and f) adults with health insurance. Five out of the six mentioned are adults having delays or difficulty obtaining health care, persons with HIV/AIDS, TB, hepatitis, and uncontrolled diabetes appeared to be the most prevalent. All five indicators show a greater percentage in either the 90813 ZIP code of Long Beach or the City of Long Beach in general when compared to LA County, the state of California, or the United States. Indicators for adults having delays or difficulty obtaining health care in 90813 ZIP code and persons with tuberculosis in the entire City of Long Beach were substantially higher compared to LA County, California, and the United States. • The mental health risk factors assessed in this community were the diagnosis of mental illness, substance use disorders, other psychological distress, age adjusted emergency room use because of alcohol and age adjusted hospitalization due to alcohol use. The evidence indicates that both age adjusted ER rates and hospitalization rates were the risk factors of greatest concern for the 90813 community of Long Beach. Both the rates for ER visits and hospitalizations, in general, were more than doubled in comparison to greater Los Angeles County. • Housing risk indicators were the median property value, monthly rental costs, the unemployment rate, and the poverty rate. The poverty rate was clearly a matter of concern for the 90813 ZIP code as more than twice as many individuals residing in this specific community of Long Beach are considered living below the federal poverty threshold or of lower socioeconomic status. As a result, an increasing number of people are not able to either get or maintain housing. There are more individuals living well above the federal poverty threshold and considered within the middle-class to upper-class level in LA County, the state of California, and the United States than in the 90813 ZIP code. Additionally, the median property value in the city of Long Beach and the unemployment rate in the 90813 ZIP code are further evidence of issues in the community that need intervention in order to reduce the risk of homelessness.

9. Future Research • Recommendations include obtaining data for specific psychiatric conditions in the mental health domain, such as major depression and PTSD, to gain a better understanding of the mental health needs of the targeted area and population. • Protective factors should be considered for future studies within the 90813 ZIP code. In addition, consider exploring major hospital organizations for additional funding to address the physical health risk factors that inhibit the overall well-being of chronic homeless individuals as well as to identify opportunities for creating unique integrated programs for this population. Implications for SW Practice • A community health risk assessment can aid social workers in their efforts in reducing and ultimately ending the vicious cycle of chronic homelessness, not only in the City of Long Beach 90813 ZIP code but in other diverse communities as well. It is a helpful tool that can be utilized to better grasp the areas of risk that are specific to a particular community, such as 90813 as presented here. • More advocacy groups pushing legislators for more funding for all four Continuums of Care in Los Angeles County are vital.

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