LAS VEGAS — Maurice Clark huddled in his tent alongside dusty railroad tracks as two homeless-outreach staff started asking him questions to find out whether or not he would qualify without spending a dime or sponsored housing.
Did he use medication? Had he ever been in jail? How many instances had he been to an emergency room? Had he been attacked on the streets? Tried to hurt himself? Engaged in intercourse for cash?
Clark didn’t really feel comfy being trustworthy with the 2 surveyors he’d by no means met earlier than, who have been flanked by cops as they recorded his responses from a questionnaire on a pill.
“I’ve done some crazy things to survive, but I’m, like, I’m going to say no because there’s these officers right there,” he mentioned, recalling the encounter on a fall afternoon outdoors his tent.
“I’m a Black man in America, so asking this stuff hits a little bit different.”
National homelessness specialists and native leaders say such private questions exacerbate racial disparities within the ranks of the nation’s unhoused, notably as extra individuals experiencing homelessness compete for scarce taxpayer-subsidized housing amid a deepening affordability disaster.
Clark was given a questionnaire by two homeless-outreach staff flanked by cops.(Angela Hart/KFF Health News)
Vulnerability questionnaires have been created to find out how seemingly an individual is to get sick and die whereas homeless, and the system has been adopted broadly across the nation over the previous decade to assist prioritize who will get housing. The extra a homeless particular person is perceived to be weak, the extra factors they rating on the questionnaire and the upper they transfer within the housing queue. The surveys are being singled out for worsening racial disparities by systematically putting homeless white individuals on the entrance of the road, forward of their Black friends — partly as a result of the scoring awards extra factors for utilizing well being care, and depends on belief within the system, each of which favor white individuals.
Black individuals make up 13.7% of the general U.S. inhabitants but account for 32.2% of the nation’s homeless population. White individuals, together with some individuals of Hispanic descent, make up 75% of the nation and symbolize 55% of America’s homeless.
“It’s racist in a systemic way,” mentioned Marc Dones, a California-based policy director on the University of California-San Francisco and a lead researcher for one of many nation’s largest studies analyzing the Black homeless inhabitants. “If you’re a white person, the more likely you are to rank higher than if you’re a Black person, so you’re more likely to get selected for housing.”
Vulnerability surveys took off after President Barack Obama in 2009 signed into legislation sweeping guidelines requiring the nation’s native homelessness businesses, often called Continuums of Care and at the moment numbering 381, to undertake a technique to evaluate the vulnerability of homeless individuals to obtain federal housing and homelessness funding. Cities and counties predominantly adopted a survey referred to as VI-SPDAT, which continues to be utilized by an estimated two-thirds of homeless businesses, even because it has been found to favor white people and rank Black individuals decrease.
Some specialists argue it’s time to toss the vulnerability evaluation altogether and look not solely at well being and social wants but additionally systemic racism, poverty, involvement within the legal justice system, limitations to housing, and different financial drivers that affect, and in some cases cause, homelessness. Several U.S. communities are revamping their vulnerability evaluation methods to cut back racial disparities and assist extra Black individuals get housing.
In Los Angeles, officers are launching an effort to make use of synthetic intelligence to raised assess whether or not somebody ought to be prioritized for placement, partially by taking a look at overpolicing of Black people and discrimination in health care. In Las Vegas, officers are revamping their vulnerability evaluation to present increased scores for systemic issues together with incarceration. In Austin, Texas, officers are testing a system to account for individuals displaced by gentrification.
“We need to own the racism that is embedded in our systems,” mentioned Quiana Fisher, vp of homelessness response methods for the lead company in Travis County, Texas, which incorporates Austin. “It’s not just about the tool — it’s about funding, and it’s about program outcomes. Even if it’s unintentional, we have created a homeless response system that is rooted in racism.”
The evaluation device was first tested in Boston, the place members of the homeless inhabitants have been extra more likely to be white, male, and have a extreme psychological sickness or substance use dysfunction. Black individuals, in the meantime, usually tend to be homeless due to financial causes, akin to poverty or joblessness, and are much less more likely to have a report of medical care on account of increased uninsurance and fewer use of well being care.
“This whole system was piloted on this older white population in Boston, so it does a poor job of capturing the needs of Black folks, who don’t tend to be as sick as white folks — they’re more broke,” Dones mentioned. “The initial thought was to prioritize these people because they’re going to die sooner. It was trying to tackle mortality, but it wound up in racism.”
Outreach staff Bryon Johnson (heart) and Nick Freddes (left) discuss to Clark in October.(Angela Hart/KFF Health News)
As a end result, white individuals are extra more likely to achieve housing as a result of they have an inclination to attain extra factors on vulnerability assessments that rank illness increased, together with histories of continual illness, dependancy, psychological sickness, and emergency room visits and hospitalizations, based on national surveys. Black individuals, in the meantime, are much less more likely to have medical insurance or medical diagnoses and to disclose their illnesses, and are more mistrustful on account of biases within the well being care system. “Black folks are less likely to seek care, even with coverage, due to medical racism,” Dones mentioned.
Local leaders say a part of the issue is turning into homeless within the first place and financial disadvantages that drive extra Black individuals into homelessness, together with placement in foster care and better charges of eviction and joblessness. But as soon as homeless, serving to Black individuals get into stable housing turns into extra elusive.
In Los Angeles County, dwelling to extra homeless individuals than another county within the nation, 31% of homeless individuals are Black, although the general Black inhabitants accounts for 9%. In Austin, Black individuals account for almost 32% of the homeless inhabitants, in contrast with 7.6% total. And in Clark County, which incorporates Las Vegas, Black individuals symbolize 42% of the homeless inhabitants however simply 12% of the general inhabitants.
“We’ve failed to capture the complex vulnerabilities of our marginalized groups. We’re asking all these questions, but we created a waiting list to nowhere,” mentioned Brenda Barnes, who leads the Southern Nevada Homelessness Continuum of Care.
Streets of Las Vegas
Grasping his toothbrush after cleansing up in his tent on a current morning, Clark, 45, recalled taking his housing questionnaire this 12 months. He ticked off responses to outreach staff that ought to rank him excessive within the queue — he lacked steady housing, has been homeless for almost 4 years, and has no job or dependable earnings.
He’d frequented emergency rooms and had been to jail, pleading responsible to a felony theft crime he mentioned he didn’t commit, and a number of other instances for possession of medication and paraphernalia, he instructed them. He used methamphetamine, principally to be alert at evening when it turned harmful. Was he ever assaulted? Yes, particularly in maturity since turning into homeless in 2020.
In actuality, he hustled generally for a dime, and he anxious he’d be focused for taking recyclables or partaking in prostitution. “I’ve done it to get a room for a night. It’s like a last resort,” he mentioned.
And Clark wasn’t forthcoming with outreach staff concerning the particulars of his drug use or involvement with legislation enforcement, that he’d offered his physique for intercourse, that he’d skilled abuse. He couldn’t recall all the main points of his medical historical past both. Continually fleeing legislation enforcement sweeps along with his tent, hauling it alongside busy practice tracks, he’s excessive at instances, and sometimes in a state of chaos and worry that may scramble his reminiscence or make him frightened of arrest. He didn’t share with them his occasional ideas of suicide or his well being considerations, together with presumably having diabetes.
“They asked me about drugs, I was like, um, I don’t know,” Clark mentioned. “Like I’m supposed to tell them I got addicted to meth or sold my body for a meal and hotel room? I had no idea where this information was going or what it was being used for.” After he took the survey, no housing got here.
John Harris, who’s homeless, has taken a housing evaluation a few instances however says he didn’t rating excessive sufficient to qualify.(Angela Hart/KFF Health News)
Even those that do reply truthfully discover themselves competing for a restricted provide of inexpensive housing. John Harris was sleeping below a bridge on a current October afternoon. He mentioned he has taken the questionnaire twice. It led nowhere.
“They asked me, have I been incarcerated? And I said yes. I’ve been to prison too many times. And I have mental health struggles,” mentioned Harris, 59, who has been out and in of sober residing shelters however nonetheless makes use of methamphetamine. He has been a repeat customer to emergency rooms, and on an October afternoon recorded a hypertension studying that put him in danger for a coronary heart assault — components that ought to rating factors for vulnerability.
“I called and asked what happened with my housing. They said I didn’t score high enough,” he mentioned. After getting his blood stress checked by a road medication nurse, he shrugged, saying he may wind up again within the emergency room, as he retreated below the bridge.
“No matter what society says today, things ain’t never going to change,” he mentioned.
‘I Don’t Know What the Solution Is’
How communities assign factors to homeless individuals and rank them for housing is the most important downside.
The commonest questionnaire deployed by communities across the nation, the VI-SPDAT, assigns factors meant to gauge the vulnerability of an individual residing on the streets. Experts say this mannequin was by no means examined as a housing evaluation device, nor meant to find out whether or not somebody will get into housing.
“This is not a reliable instrument, and Black men consistently score the lowest for vulnerability, so they are deprioritized for housing — to get housing, you really need to score high,” mentioned Courtney Cronley, a University of Tennessee researcher who analyzed the vulnerability evaluation. Her findings were published in 2020 within the Journal of Social Distress and Homelessness.
Cronley pointed to a spread of questions that exacerbate racial bias and have little to do with qualifying for housing:
How many instances have you ever obtained well being care in an emergency room? Have you been attacked or crushed up? Have you threatened to hurt your self or anybody else within the final 12 months?
Does anybody drive you or trick you to do issues that you do not need to do? Do you change intercourse for cash? Run medication?
Experts who research the vulnerability questionnaire additionally level out that the racial or ethnic background of surveyors usually doesn’t replicate that of the individuals being questioned, which may result in inaccurate outcomes if a respondent doesn’t really feel secure or perceive the survey’s function.
Some cities and counties are creating surveys that native homeless businesses hope will slender racial disparities.
Clark County deployed a brand new vulnerability evaluation in June after a 2023 secret-shopper challenge discovered the system was not connecting homeless individuals with housing or providers, particularly individuals of shade.
“We failed in every category,” Barnes mentioned. Formerly homeless individuals fanned out on the streets and within the tunnels to check whether or not the housing questionnaire resulted in offering housing for essentially the most weak. “All we were doing is counting people.”
Harris will get his blood stress checked on an October afternoon.(Angela Hart/KFF Health News)
Clark County’s new weighted questionnaire now considers how seemingly an individual is to exit homelessness on their very own — as a substitute of how seemingly they’re to die on the streets or within the tunnels.
The new system assigns homeless individuals factors in 4 classes to get increased within the queue for housing: whether or not somebody is pregnant or a dad or mum; whether or not they have a substance use dysfunction, continual well being situation, or psychological well being analysis; whether or not they’re 55 or older; and whether or not they have dedicated a felony or violent crime.
“Because you’re not going to get approved for a job or housing if they run a background check and there’s a criminal record,” she mentioned, “so we want to address that in our housing system.”
Still, Barnes isn’t certain Clark County will get it proper this time. As of mid-November, extra homeless Black individuals have been ready for housing than white individuals. According to native information obtained by public data requests, almost 1,500 Black individuals are within the county’s housing queue, in contrast with roughly 1,000 white individuals.
“I don’t know what the solution is,” Barnes mentioned. “To be honest, the numbers may spike again.”
Los Angeles County, the place an estimated 75,000 people expertise homelessness, is making a weighted device to assign extra factors for components that disproportionately have an effect on individuals of shade.
If somebody has been incarcerated or detained by legislation enforcement, as a substitute of getting one level, a homeless particular person would rating 5, transferring them up on the housing listing, mentioned Eric Rice, a social scientist and professor on the University of Southern California.
“We are assigning more points to structural inequities,” mentioned Rice, who helps develop the brand new questionnaire.
Los Angeles County additionally plans to assign extra factors for drug use and for having HIV, which impacts Black males greater than another group. New HIV diagnoses for Black adults have been eight instances these of white individuals, based on analysis by KFF, a well being info nonprofit that features KFF Health News.
Homelessness coordinators have additionally revamped their vulnerability evaluation in Travis County, Texas, the place a Black resident is six times as more likely to fall into homelessness as a white particular person.
The county’s homelessness company, based on Fisher, checked out traditionally Black neighborhoods in Austin that had been gentrified and scored homeless individuals increased in the event that they’d lived in these areas however have been now homeless.
“If you lived in a place that was previously redlined or now gentrified, you got a point for that,” Fisher mentioned. The survey additionally gave factors for involvement within the legal justice system, as a result of Black individuals are extra more likely to get arrested or jailed, she mentioned.
Some specialists say the thought of utilizing a device to rank individuals ought to disappear altogether.
Instead, communities ought to have flexibility to tailor their housing assets based mostly on the native wants and demographic make-up of their homeless populations, mentioned Mary Frances Kenion, vp of coaching and technical help on the National Alliance to End Homelessness.
She mentioned communities can domesticate belief between homeless individuals and outreach staff by a one-on-one strategy that may be extra attentive to particular person wants and native housing circumstances, which may higher decide whether or not somebody ought to be moved to the highest of the housing listing.
Kenion additionally inspired federal, state, and native governments to reimagine their strategy to prioritizing individuals for housing based mostly not on vulnerability however financial components like earnings, historical past of eviction, or having a felony report. She argued communities ought to dedicate extra assets to stem the move of Black individuals into homelessness.
“If we don’t manage to stop that,” she mentioned, “this is just going to keep getting exponentially worse.”
This article was produced by KFF Health News, which publishes California Healthline, an editorially impartial service of the California Health Care Foundation.
Angela Hart:
[email protected],
@ahartreports
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