U.S. Department of Housing and Urban Development (HUD)
Serving Unsheltered People with
Severe Service Needs
People who are experiencing unsheltered homelessness are a priority for the U.S. Department of Housing and Urban Development (HUD), as evidenced by a Continuum of Care (CoC) Supplemental to Address Unsheltered and Rural Homelessness Special Notice of Funding Opportunities (Special NOFO) issued by the Office of Community Planning and Development in September of 2022. Through this initiative, HUD is promoting coordinated approaches—grounded in Housing First and public health principles—to reduce the prevalence of unsheltered homelessness and improve services, health outcomes, and housing stability among highly vulnerable unsheltered individuals and families. This Special NOFO, designed in collaboration with people with lived experience of homelessness, outlines strategies communities may implement to address the severe service needs of unsheltered people within their homeless response systems and supports serving the needs of people with complex and multiple service needs. It assists CoCs in their efforts to identify and connect people living in unsheltered situations, including encampments, with health and housing resources.
Fast Facts
Most common diseases among people experiencing unsheltered homelessness:
- Cardiovascular disease
- Diabetes mellitus
- Hepatitis
- Communicable diseases (e.g., COVID-19)
- HIV/AIDS
- Influenza
- Substance use disorders
- Tuberculosis
Most common conditions among people experiencing unsheltered homelessness:
- Chronic pain
- Cognitive impairments from traumatic brain injuries
- Disability
- Extreme weather-related injuries
- Mental illness
- Trauma
- Oral and visual health concerns
- Inadequate nutrition
- Reproductive health concerns
Equity Considerations and Barriers
People with high service needs are often members of stigmatized groups in society. Stigma and discrimination impact the health and healthcare needs of vulnerable populations. Social stigma can be identified as the negative perceptions, attitudes, and characteristics a society places on individuals and group members. Social stigma feeds the prejudices and discrimination people with high acuity service needs can encounter based on those needs and the intersectionality of group identities inclusive of being identified as experiencing homelessness. Another consideration is the disparity in access to, and quality of, health care individuals can experience due to long-standing structural and systemic oppressive practices and behaviors that support negative outcomes for the stigmatized in society. Meeting the service needs of individuals and families when race, ethnicity, sexual orientation, gender identity, language, family, undocumented status, and other identifying factors serve as barriers requires homeless service providers and physical, behavioral, and mental health practitioners to identify ways to bridge the gap between people with high acuity and those who can support them in obtaining and providing the services they need. The Primer on Serving People with High-Acuity Needs provided insight for responding to peoples’ high-acuity needs during the pandemic and can be a guide to address common diseases and conditions.
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