Learning from data on homeless students

“Homelessness up again in King County” – the recurring headline, steady as a drumbeat, reminds us of the paradox of our region’s economic prosperity:  A flourishing job market increases competition for housing and squeezes out lower- and middle-income households.  Data informing most policy decisions about regional homelessness come almost exclusively from two sources – COUNT US IN (also known as the Point-in-Time or One-Night Count), and the Seattle/King County Homeless Management Information System (HMIS), a secure online database of information about services provided to people experiencing homelessness.

A third dataset –  HOMELESS STUDENTS DATA (an annual report prepared by the Washington Office of the Superintendent of Public Instruction) – offers a wealth of information about family homelessness, but so far has not been used to guide policy for prevention or mitigation of homelessness.

Although COUNT US IN and HOMELESS STUDENT DATA are updated annually, overlap in the individuals they count is limited by differences in method and definition:

Method

  • Each January, COUNT US IN sends out teams of volunteers to provide a one-time “snapshot” of the number of people of all ages who are experiencing homelessness. This includes counts of sheltered and unsheltered individuals plus an in-person survey of a subset of these individuals. The method is inherently conservative, and its report acknowledges undercounting homeless individuals in suburban and rural communities and those in hard-to-reach subpopulations such as unsheltered families and unaccompanied youth.
  • HOMELESS STUDENTS DATA are collected throughout the school year by teachers and other school personnel and provide a count of students (preschool through grade 12) who were known to be homeless at any time during the academic year.

Definition

  • While both data sources count as homeless people living unsheltered or sheltered (in emergency shelters, transitional housing, or safe havens), COUNT US IN, following criteria specified by the U.S. Department of Housing and Urban Development (HUD), excludes homeless individuals and families who are “doubled up” with friends, family, or others in homes, hotels/motels, or other arrangements.
  • In contrast, following specifications from the U.S. Department of Education and the Washington State Legislature, HOMELESS STUDENTS DATA includes “doubling up” in their definition of homelessness: about 2/3 of students without a stable home in the most recent (2016-17) count were doubled up.

Differences aside, both counts lead to the same sorry conclusion:  As the fortunes of some King County residents are tracking the region’s recovery from The Great Recession, increasing numbers of our neighbors are becoming homeless.  According to COUNT US IN 2018, 12,112 individuals were homelessness in Seattle/King County on January 26th, up by 4% from 2017 (due to changes in methodology in 2017, comparisons with pre-2017 counts are discouraged).  Similarly, HOMELESS STUDENTS DATA reported that 8,938 King County public school students experienced homelessness during the 2016-17 school year, up by 8% from the previous year and more than double the number in 2010-11. The numbers of unsheltered individuals have also gone up in the most recent counts, by 15% for COUNT US IN – from 5,485 (2017) to 6,320 (2018) – and by 39% for HOMELESS STUDENTS DATA – from 244 (2015-16 SY) to 339 (2016-17SY).

What can we learn by looking at these datasets together?  Striking similarities emerge when we look at subgroups in these datasets. (Complementing the data from HOMELESS STUDENTS DATA, the Seattle Atlas of Student Homelessness, an in-depth analysis of data from Seattle Public Schools by the Institute for Children, Poverty & Homelessness (ICPH) offers examples of how housing instability compounds existing disparities for outcomes such as academic achievement and school suspensions.)

  • RACIAL DISPARITIES: Blacks/African Americans and Hispanics/Latinos are disproportionately represented in both homelessness counts.
  • DISABILITIES: More than half of the COUNT US IN survey respondents said they were living with at least one disabling condition, and 21% of homeless students were in Special Education (about double the rate for students who were not homeless).
  • LIMITED ENGLISH PROFICIENCY: The COUNT US IN survey found that respondents from families with children were 6 times more likely than those without children to encounter language barriers when trying to access services. HOMELESS STUDENTS DATA reported that 22% of homeless students were “English Language Learners” (compared to 11% of students overall).
  • PRIOR HOMELESSNESS: COUNT US IN 2018 reported a 1-year increase of 779 individuals (28%) experiencing chronic homelessness; more than 1 in 5 respondents to the COUNT US IN survey first experienced homelessness when they were children, and almost half had experienced homelessness before age 25. While HOMELESS STUDENTS DATA does not report on chronic homelessness, the Seattle Atlas of Student Homelessness, found that more than half of Seattle Public School students who were homeless in the 2015-16 school year had also been homeless in previous years.
  • DOUBLING UP: More than 1 in 4 respondents to the COUNT US IN survey reported that immediately before becoming homeless they were “doubled up” (living in a home owned or rented by relatives or friends). This suggests that by counting students who are doubled up, HOMELESS STUDENTS DATA identifies students at risk of ending up on the street, in a shelter, or in transitional housing. Because repeated episodes of homelessness are common (see PRIOR HOMELESSNESS above), paying attention to the doubled-up population could eventually help reduce chronic homelessness. Currently, as noted by the ICPH report on Seattle student homelessness, “doubled-up students are not eligible for many of the same housing resources as other homeless students.”

Finally, while COUNT US IN provides homeless counts for 6 broad regions of King County, HOMELESS STUDENTS DATA offers almost a decade of data for 18 school districts across the region, revealing different patterns over time in different communities.  While the rate of homelessness has leveled off in some school districts, it continues to climb steadily in others.  In Tukwila, for example, student homelessness surged from 47 students (1.6% of enrollment) in 2007-08 to 375 (12.7%) in 2016-17 – an 8-fold increase in less than 10 years.  In the same period, the number of Seattle public school students without a stable home grew from 930 (2.0% of enrollment) to 4,280 (7.9%), while a few districts (Mercer Island, Vashon Island, and Skykomish) never had a year in which more than 20 students experienced homelessness.

REDUCING THE FLOW TO CHRONIC HOMELESSNESS?

Broadening our homelessness policy perspective to include individuals and families who are doubled up could help us identify families at risk for homelessness before they have exhausted their last personal resource (the family and friends willing to take them in).  Chicago is already looking at doubled-up families by, for the first time, linking information from their official database of homeless individuals accessing services (HMIS) with data from the public schools.  By combining data sources, they are able to better understand families’ paths to homelessness and to project future needs for services.  Following a similar course in King County could enable us to come up with a more prevention-oriented approach to what has become a chronic problem in our communities.

NOTE: Communities Count has reported on student homelessness for several years, and is about to update that indicator with 2016-17 data. To coordinate with the newly released COUNT US IN report, this blog previews key findings from that update.

Troubling trends for homelessness, physical activity, food security, and drug-related deaths

Part I of our double blog on recent trends in King County focused on some of the good news from King County Hospitals for a Healthier Community’s new Community Health Needs Assessment.  Now we’ll look at some of the more challenging findings.

Part II.  ACROSS KING COUNTY OVERALL, WHAT’S FAILING TO IMPROVE OR GETTING WORSE?  While many indicators showed little or no improvement in the 3 years since the previous report, those with special relevance for healthcare providers were highlighted in the Community Health Needs Assessment.

Homelessness:  In the context of escalating housing prices, student homelessness in King County more than doubled since 2008, reaching 8,411 (2.9% of enrolled students) in the 2015-16 school year. In 2016-17, this increased further, to 9,407 (3.2% of enrollees).

  • In most school districts, more than 40% of homeless students were in elementary school or pre-kindergarten.
  • In addition to student homelessness, the 2017 Count Us In Report identified 11,643 individuals experiencing homelessness, 50% of whom had one or more disabling conditions.

Too little physical activity: Fewer than 1 in 4 King County adults and youth get the recommended amount of exercise. Insufficient physical activity is associated with obesity, which in turn is linked to diabetes and other chronic diseases (including 4 in 10 cancers diagnosed in the United States).

  • This represents no change for adults, and modest but inadequate improvement for 8th, 10th, and 12th graders, given the importance of physical activity to health.
  • The overall obesity rate for King County adults has been flat since 2009 (at more than 1 in 5 adults). Nationally, adult obesity levels rose for decades, stabilized between 2003 and 2012, then rose again slightly for women.
  • At 22%, the 2015 adult obesity rate in King County was significantly lower than the Washington state rate of 26%, and the national rate of 29% (although the 2011-2015 rate in South Region matches the national rate, at 29%).
  • For King County youth, obesity has held steady around 9% since 2004 except in South Region, where it has increased. In comparison, high school students nationally experienced a steady increase in obesity from 1999 to 2013, which appeared to level off at a higher rate -14% in 2015.

Food insecurity:  By 2016, King County participation in the Basic Food program (formerly food stamps) had not returned to pre-recession levels and was increasing for older adults, especially in South Region.

  • A similar pattern was found for visits to King County food banks.
  • Although survey data about food hardship (running out of food without money to buy more) have not been collected since 2013, use of food assistance is often associated with food insecurity.

Feeling depressed: On the mental health front, 30% of youth reported that, every day for 2 or more consecutive weeks, they felt so sad or hopeless that they stopped doing some of their usual activities.

  • This indicator of depressive feelings has gotten worse in King County since 2004, driven by increases among youth in South Region.
  • Among adults, reports of frequent mental distress (poor mental health in at least 14 of the past 30 days) have increased among Hispanics since 2005, but remained stable among other race/ethnicity groups.
  • While the percentage of heterosexual adults reporting serious psychological distress has been flat since 2009, feeling “nervous, hopeless, restless, depressed, worthless, or that everything was an effort” within the past 30 days has increased significantly among lesbian, gay, and bisexual adults.

Drug-related deaths, especially those related to heroin and methamphetamine, increased dramatically between 2010 and 2016.  New data released last week revealed a 10% increase (from 348 to 379) in King County drug-related deaths in 2017.

What’s UP in King County?

In the midst of rapid economic growth, population growth, and increases in the cost of housing, how are the people who live in King County communities faring?  The new Community Health Needs Assessment released by King County Hospitals for a Healthier Community (HHC) offers a data-informed overview of how we’re doing.    

In a pair of blog posts, we look at what’s changing in our increasingly diverse county – in positive and negative directions.  First, the good news:

Part I.  ACROSS KING COUNTY OVERALL, WHAT’S GETTING BETTER?

Although disparities remain, 3 county-wide successes stand out. (To look at change over time in the hyperlinked visualizations below, please click on the “trends” tabs.)

Since implementation of the Affordable Care Act, health insurance coverage has improved dramatically – for all ages, racial/ethnic groups, and cities.

  • But… most communities of color remain disproportionately uninsured and residents of low-income neighborhoods were least likely to receive recommended preventive services such as vaccines, screenings, and dental care.

Cigarette smoking – still the leading preventable cause of death in the United States – has declined for adults and youth across regions, age groups, and racial/ethnic groups.  For youth, the decline in smoking was accompanied by a decline in overall tobacco use (combining cigarettes, chew, cigars, and hookah), exposure to secondary smoke at home, and use of alcohol, marijuana, painkillers, or illicit drugs.

  • But… smoking is inversely linked to income, with adults with in the lowest-income group 4 times more likely to smoke as those in the highest-income group.

Fewer students in 8th, 10th, and 12th grades are drinking non-diet sodas and other sugar-sweetened beverages daily, mirroring a national trend among high school students.

  • But… students in South Region are more likely than students in other regions to drink sugar-sweetened beverages.

All of these improvements occurred in the context of supportive policy changes – at the federal, state, county, city, and/or school levels.  Nevertheless, some improvements are swamped by the magnitude of ongoing disparities. For example, although health insurance for Hispanic adults improved by 11% between 2013 and 2016, 21% of Hispanic adults were still uninsured in 2016, compared to 4% of non-Hispanic white adults.

While we’re making progress, we still have a ways to go.

How are guns stored in King County homes?

Across all of King County, more than 1 in 5 adults reported keeping a gun in or around their homes, including in a car or other motor vehicle.  But where they lived made a big difference: Keeping a gun at home was least likely in Seattle neighborhoods (14%) and most likely in rural areas in east and south King County, with the highest rate (43%) in Covington / Maple Valley and Newcastle / Four Creeks.

To help gun owners protect their children and neighbors against accidental shooting, access by children, firearm suicides, and firearm theft, Public Health – Seattle & King County is partnering with firearms retailers, elected and tribal leaders, local hospitals, and law enforcement on the LOK-IT-UP safe storage initiative.

The same survey that asked about keeping guns around the home also asked how those guns were stored. In 2015 —

  • 43% of respondents with guns at home (about 150,000 people) said they stored at least one gun unlocked
  • 31% (about 105,000 people) stored at least one gun loaded
  • 15% (about 51,000 people) stored at least one gun unlocked and loaded

So we have room for improvement. While opinions are divided about gun legislation, we are united in wanting our children, families, schools, and communities to be safe.  

For more information about LOK-IT-UP, see the 10/31/2017 Public Health Insider blog; for background information about gun-violence prevention, see King County’s Gun Violence Prevention Initiative. Communities Count has just introduced two new indicators, with interpretive narrative, under the Public Safety topic: Homes with guns  and Carrying weapons at school.  These indicators, plus data on Not feeling safe at school, are also available at Public Health’s Community Health Indicators site. The LOK-IT-UP site provides information on how to get discounts on storage devices and lock boxes through December of 2018.

Live from King County, it’s interactive data!

For the first time, extensive interactive data on health and well-being in King County communities is available on Public Health’s Community Health Indicators website.  This rollout of new data coincides with the release of the 2018/2019 Community Health Needs Assessment for King County Hospitals for a Healthier Community.

Check out some of the new visualizations by clicking on the hyperlinked indicators in the bulleted text below. Once a visualization opens, you can click on the tabs above the title banner (see image above) to explore additional features.

  • Where in King County do more than 40% of households have guns? The cities/neighborhoods tab of the “firearms stored in home” maps the data to 48 sub-county geographies.
  • What proportion of King County residents have “unmet health care needs due to cost”? The summary tab displays a map that shows the range of values at the bottom, describes the data source, and reports the most recent 1-year and 5-year King County averages.
  • What’s the best predictor of a woman getting “early and adequate prenatal care” during pregnancy? In this demographics tab, bar charts compare results by mother’s age, education, race/ethnicity, and location.
  • Since legalization in 2012, how has marijuana use changed among King County adults and teens? Trend tabs show changes over time in King County, for King County regions, by race/ethnicity, and by sexual orientation (for adults).
  • How can you map “tuberculosis incidence” for people who don’t have an address? The Notes and sources tab answers this question and provides additional information and resources about the indicator.

Helpful hints: For legends (including options to select categories/groups and show/hide confidence intervals) see right margin of charts.  Hover over a colored bar, line, or map area to bring up a floating box with detailed information about the data.  Click on a bar, line, or map area to highlight that area; click anywhere else inside the chart to return to your previous view. For illustrated instructions, see this blog from Best Starts for Kids.

If you have questions or comments, please contact data.request@kingcounty.gov.