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New Center at Mailman School Seeks Solutions to Chronic Homelessness

More than 30,000 homeless people live in shelters in New York City, with a substantial but unknown additional number who are homeless but unsheltered.

More than 30,000 homeless people live in shelters in New York City, with a substantial but unknown additional number who are homeless but unsheltered. In the United States, more than 800,000 people are homeless on any given day, with 2.3 million to 3.5 million experiencing a period of homelessness over the course of a year.

The National Institute of Mental Health has awarded $5 million to researchers at the Mailman School of Public Health to establish the Columbia Center for Homelessness Prevention Studies. The center is a multidisciplinary effort to research homelessness and develop ways to prevent chronic homelessness among people with severe mental illness, who comprise about 25 percent of homeless adults 18 and older. It is the country's only NIMH-funded research center for the development of new and effective approaches for homelessness prevention among people with severe mental illness.

"Our center is unique because it brings together colleagues from so many different disciplines, from psychiatry and social work to urban planning and economics," says Carol Caton, Ph.D., center director, principal investigator and research scientist at the New York State Psychiatric Institute.

Dr. Caton, also a professor of clinical sociomedical sciences at the Mailman School, has been researching the problem of homelessness for more than 20 years. She and Ezra Susser, M.D., Dr.PH, and center co-director, formed a group made up of Columbia faculty, providers of services to the homeless, consumers, and city and state policy makers who will work collaboratively to develop new and better ways to help the homeless and those at-risk of homelessness to retain safe, adequate, and affordable housing.

"Research at the center will fill a clear void," says Dr. Susser, also the Anna Cheskis Gelman and Murray Charles Gelman Professor and chair of the Mailman School's Department of Epidemiology and professor of psychiatry. "The majority of existing research on homelessness is descriptive – defining the number of homeless, who is homeless, and identifying risk factors. We need to go much further to understand the underlying causes of chronic homelessness and speed up the development, testing and dissemination of effective interventions to prevent the newly homeless from becoming chronically homeless."

In its mission to become a national resource, the center also is working with researchers at medical centers affiliated with Dartmouth, Harvard, Yale, and New York University. It also is collaborating with providers of health and housing services and local and state agencies, including the New York City Department of Homeless Services and the New York City Department of Health and Mental Hygiene.

"New York City makes a good laboratory for this work," Dr. Caton says. "It not only has the highest population of homeless in the country, but also is the only U.S. city whose citizens have a legal right to shelter. The city's academic psychiatrists and mental health services researchers have been in the forefront of efforts to understand contemporary homelessness and initiate creative responses in program development, policy, and advocacy. The new center promises to help accelerate efforts to bring about solutions to the public health problem of homelessness."

Having received the grant in September, the center already has launched several studies. Among them is the development of a fidelity manual – which describes the key elements of an intervention in a measurable way – for the "housing first" approach, to be carried out in collaboration with Pathways to Housing. This community agency pioneered an approach that enables people living on the street to immediately gain access to housing and supportive treatment services. A second study explores the stability of living arrangements for formerly homeless people with severe mental illness, whether it's living with a family member, in a group home, or in an apartment.

To foster communication about homelessness and maximize participation of students and faculty throughout the medical center, Dr. Caton says the homelessness study center plans to hold grand rounds and monthly luncheon discussions for students and faculty. It also will provide support and mentoring services for trainees and fellows, practica for students who hold a master's degree, and a pilot funding program for junior investigators. For more information, contact the center at 212-305-3503.

—Adar Novak

Researchers Apply Long Track Record to Homelessness Studies

Several of the researchers who will conduct work under the auspices of the Columbia Center for Homelessness Prevention Studies also helped run a Critical Time Intervention (CTI) program, which, from 1990 to 1994, served homeless men with severe mental illness at the Fort Washington Men's Shelter in Washington Heights. The goal of that program – funded by the National Institute of Mental Health – was to help prevent the men from becoming homeless again as they made the transition from the shelter to community-based housing. The CTI program, one of the Stewart B. McKinney Homeless Assistance Act Demonstration Projects, has been recognized by the President's New Freedom Commission on Mental Health as an evidence-based program and as a model program by the Substance Abuse and Mental Health Services Administration.

Since then, Columbia researchers have worked on additional CTI programs, including one for mentally ill homeless veterans and another for homeless families in Westchester County. Daniel B. Herman, D.S.W., M.S., assistant professor of clinical epidemiology at the Mailman School of Public Health, is studying CTI programs that help homeless people who are patients in state hospitals make the transition to permanent housing.

"The new Center for Homelessness Prevention Studies has a much wider scope than previous projects but CTI is expected to be a featured intervention that will be studied in different settings and with different populations under the auspices of the center," Dr. Susser says.