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FSPH’s Randall Kuhn: What Public Health Practitioners Can Do About Homelessness

Randall Kuhn, associate professor of community health sciences at the UCLA Fielding School of Public Health, recently helped organized a conference at UCLA that explored solutions to homelessness. In this interview with FSPH, he shares his thoughts on how the public health community can support people who find themselves without a home. 

Tuesday, June 5, 2018

More than 53,000 people in Los Angeles County experience homelessness on any given night, according to the Greater Los Angeles Homeless Count. In order to better understand how to support the local homeless population, faculty members from the UCLA Fielding School of Public Health joined colleagues from several other disciplines to explore solutions at the conference, UCLA & Homelessness: See. Study. Solve. that took place on campus from May 21-24.  

Randall Kuhn, an associate professor of community health sciences at the UCLA Fielding School of Public Health who helped organize the event, recently shared his thoughts on what the public health community can do to address homelessness.

Q: What inspired you to organize this event?

A: I have been troubled by the ongoing homelessness crisis in Southern California, particularly given that cities in the Eastern U.S. have had so much success in reducing homelessness in the past couple decades. I was also optimistic about the prospect of serious change when LA County passed ballot measures in 2016 and 2017 to provide funds to build housing for homeless people.

At around the same time, I started talking to my event co-organizer Till Von Wachter, who directs the California Policy Lab. We noticed that a number of different groups on campus and in LA were working closely with my colleague Dennis Culhane of the University of Pennsylvania. Dennis has devoted his life to using innovative data sources to better serve the needs of highly disadvantaged populations, especially the homeless. He led a study I worked on 20 years ago that identified the distinct groups of chronic, episodic and crisis homeless shelter users, and helped to design programs that target their unique needs. We asked Dennis to host this event with us.

Q: What were the main takeaways from the conference?

A: For years, homelessness programs achieved incredible success with a "housing first" model that identified housing as the critical and immediate need for those facing homelessness, and a platform for getting other help like employment, treatment and social support. The "housing first" model still holds true, but the conference illustrated two things. First, housing can mean different things to different people, whether it's avoiding eviction in the first place through better financial support and legal protections, or gaining access to a constellation of short- and long-term housing options, or using what we call a "shallow subsidy," a small short-term financial support to get into a wide range of rental, shared or extended family housing situations. LA is in a full-blown housing crisis that affects far more than the few percent who are homeless in any given year. We need to get more housing development into the pipeline, especially the kind of housing that families actually need, but in the meantime we must and can be very creative about it.

Secondly, a lot of people won't get rehoused overnight, and they have a great many needs that can nevertheless be met even as they make their transition into housing. And for people who get housing but have high-service needs – those with mental illness, HIV/AIDS, or other chronic conditions – housing can come first, but services need to follow. Many homeless people spend their whole lives navigating complex webs of health care providers that we all find daunting. One thing that interests me a great deal is the potential role of information technology, especially mobile phones, in helping people who are homeless gain access to the services they need. For many people who are homeless, mobile phones, library internet connections and social networks are a lifeline. Something as simple as getting to a doctor's appointment in Hollywood from downtown could involve a couple days of walking and camping. A mobile phone could help you find a different doctor, reschedule, request a ride or just get a top-up on your LA metro card so you can get where you need to go. 

Q: What can we do as a public health community?

A: Aside from making sure the right health services are delivered, one major role for public health is in making the challenge of homelessness relatable for citizens. Knowing how many people in your midst have been homeless, even for those of us who live lives of relative comfort, is really important. Another piece is helping correct misconceptions about the homeless, particularly surrounding the notion of a long-term homeless person with severe mental health issues. In fact, many of the people you see on the street and in encampments have been homeless for an incredibly short time and just need a helping hand -- some services, some subsidies and the right information -- and they can help themselves in short order. When LA County Supervisor Sheila Kuehl was honored at the UCLA Fielding School of Public Health’s 2018 Ruth Roemer Social Justice Symposium in early May, she highlighted LA County's new programs that provide loans for people who build prefabricated guest houses on their properties and forgives those loans if they rent these units to a homeless person or family. This is an amazing program. But to maximize its impact, we need to understand that people can find themselves homeless for a variety of reasons. One way to be supportive is to recognize that by renting a room or an apartment, you will be gaining a neighbor who you can talk to or who may have valuable skills to bring to your neighborhood.