Assessing the Prevalence of Women and Children in Skid Row

San Gabriel Valley and Metropolitan Service Planning Area Health Office (SPA 3 & 4 )

SPA 3 & 4 PROFILE

ASSESSING THE PREVALENCE OF WOMEN AND CHILDREN IN SKID ROW A Rapid Assessment Survey

SPA 3 & 4 BEST PRACTICE COLLECTION RELIABLE INFORMATION FOR EFFECTIVE COMMUNITY HEALTH PLANS, PROGRAMS AND POLICIES

M. RICARDO CALDERÓN, SERIES EDITOR

June 2003

Los Angeles County Department of Health Services • Public Health

At a Glance SAN GABRIEL VALLEY SERVICE PLANNING AREA (SPA 3) METROPOLITAN SERVICE PLANNING AREA HEALTH OFFICE (SPA 4) 241 North Figueroa Street, Room 312 Los Angeles, California 90012 (213) 240-8049

The Best Practice Collection is a publication of the San Gabriel Valley (SPA 3) and Metropolitan Service Planning Area (SPA 4). The opinions expressed herein are those of the editor and writer(s) and do not necessarily reflect the official position or views of the Los Angeles County Department of Health Services. Excerpts from this document may be freely reproduced, quoted or translated, in part or in full, acknowledging SPA 3 & 4 as the source.

Internet: http://www.lapublichealth.org/SPA 3 Internet: http://www.lapublichealth.org/SPA 4

LOS ANGELES COUNTY BOARD OF SUPERVISORS

Gloria Molina, First District Yvonne Brathwaite Burke, Second District Zev Yaroslavsky, Third District Don Knabe, Fourth District Michael D. Antonovich, Fifth District DEPARTMENT OF HEALTH SERVICES Thomas L. Garthwaite, MD. Director and Chief Medical Officer

Jonathan E. Fielding, MD, MPH, MBA. Director of Public Health and County Health Officer

James Haughton, MD, MPH. Medical Director, Public Health

BEST PRACTICE COLLECTION TEAM M. Ricardo Calderón, Series Editor Manuscript Author & SPA 4 Area Health Officer

Christopher Corniola, MPH.

Manuscript Author & Epidemiology Analyst

The SPA 3 & 4 Best Practice Collection fulfills the Los Angeles County Department of Health Services (DHS) local level goal to restructure and improve health services by “establishing and effectively disseminating to all concerned stakeholders comprehensive data and information on the health status, health risks, and health care utilization of Angelinos and definable subpopulations”.1 It is a program activity of the SPA 3 & 4 Information Dissemination Initiative created with the following goals in mind: To highlight lessons learned regarding the design, implementation, management and evaluation of public health programs To serve as a brief theoretical and practical reference for program planners and managers, community leaders, government officials, community based organizations, health care providers, policy makers and funding agencies regarding health promotion and disease prevention and control To share information and lessons learned in SPA 3 & 4 for community health planning purposes including adaptation or replication in other SPA’s, counties or states To advocate a holistic and multidimensional approach to effectively address gaps and disparities in order to improve the health and well-being of populations The SPA 3 & 4 Information Dissemination Initiative is an adaptation of the Joint United Nations Program on HIV/AIDS (UNAIDS) Best Practice Collection concept. Topics will normally include the following: 1. SPA 3 & 4 Viewpoint: An advocacy document aimed primarily at policy and decision-makers that outlines challenges and problems and proposes options and solutions.

2. SPA 3 & 4 Profile: A technical overview of a topic that provides information and data needed by public, private and personal health care providers for program development, implementation and evaluation.

3. SPA 3 & 4 Case Study: A detailed real-life example of policies, strategies or projects that provide important lessons learned in restructuring health care delivery systems and/or improving the health and well being of populations.

4. SPA 3 & 4 Key Materials: A range of materials designed for educational or training purposes with up-to-date authoritative thinking and knowhow on a topic or an example of a best practice.

Angela Salazar, MPH.

Manuscript Author & Program Director, Health Education

Carina Lopez, MPH.

Project Manager, Information Dissemination Initiative Photo: Courtesy of

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ASSESSING THE PREVALENCE OF WOMEN AND CHILDREN IN SKID ROW

Table of Contents

I. INTRODUCTION

4

II. BACKGROUND INFORMATION

5

III. RAPID RESEARCH METHODOLOGY

5

1.

Women and Children Profile

2.

Shelter Profile/Childcare Facility Profile

IV. FINDINGS AND RESULTS

xx

6

1.

Overall

xx

2.

Shelter and Childcare Facilities i.

Union Rescue Mission ii.

The Ford Hotel iii.

Para Los Ni単os

xx 7 8 8

V. DISCUSSION AND RECOMMENDATIONS

9

VI. FIGURES AND TABLES 1.

Racial Composition of Survey Participants (all)

6

2.

Racial Composition of Survey Participants (adults)

6

3.

Racial Composition of Survey Participants (children)

7

4.

Racial Composition of SPA 4 Residents

7

VII. REFERENCES

9

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INTRODUCTION

I. INTRODUCTION Over the past few years, the United States has experienced times of great prosperity, wealth and economic growth to times of budget shortfalls, job losses and economic decline.

With the decline in the economy, an increase in unemployment is seen locally and throughout the country.

Unemployment rates have climbed to 6.7% in California and 6.8% in Los Angeles County (LAC). Lack of safe, affordable housing is also a concern in addition to unemployment as a cause of homelessness in Los Angeles. Currently, the fair-market rent for a one-bedroom apartment in Los Angeles is $746.00 per month plus the cost of utilities for a total per year over $9,000.00. For a family of four living in poverty (100% Federal Poverty Level for a family of 4 is $18,400.00) , this is approximately half of their annual income and little money for other expenses is available such as childcare, food, healthcare, etc. Another option for low-income families is Section 8 low-income housing. According to the Los Angeles County Housing Authority, the waiting list for Section 8 housing has 120,000 eligible families with a wait time of approximately 8 years.

In fact, there are families currently on the Section 8 housing list who have been there since 1988. With the rise in unemployment, the current instability of the economy and the housing shortage there is an increase in the homeless population in Los Angeles County. The exact number of homeless people is not known due to difficulties measuring an extremely transient population. However, recent data estimates that 84,000 people are homeless each night on the streets of Los Angeles.

Homelessness in America is the result of an interaction between many circumstances including, but not limited to, the supply of affordable housing, poverty, unemployment and disability. Other factors include the following: • Substance abuse, mental illness and the lack of needed services

• Low paying jobs • Domestic violence • Change and cuts in public assistance

• Changes in family structure • Chronic health problems and lack of access to affordable health care While it is clear that homelessness is a national problem, it is important to understand that the homeless population in the United States is not homogeneous and risk factors leading to homelessness vary between geographic areas.

The homeless population in Los Angeles County and the United States comprises mainly of single men without children or families. According to a study conducted by the Institute for the Homeless and Poverty at The Weingart Center in June 2000 5, the homeless population consists of 66% single adults and 34 % families. Of the homeless single adults, 77% are men and only 23% are women. However, over the last several years there has been a noticeable increase in the number of women and children that become homeless throughout locally and nationally. Currently, one-fourth of the homeless are women with children in the United States.

Although several studies have been conducted on homeless women living in Skid Row, the data is limited. A study conducted in July 2001 by the Downtown Women’s Action Coalition (DWAC)* surveyed over 400 women.

The data showed that the majority of women were African American (63%), 13% were non-Hispanic white and 11% Hispanic. Additionally, 38% of the women surveyed had children under the age of 18 and only 38% had custody of their children. Two-thirds of the women with custody had their children currently living with them.

The study also found that over 85% of the women had one source of income or public benefit.

As the number of women and children living in and around Central City East rises the need for childcare rises also. In Central City East Los Angeles, quality and affordable childcare is difficult if not impossible to find.

The average cost of childcare in Los Angeles is $650 per month for infants and $500 per month for children ages of 2-5 years. In Metropolitan Los Angeles (SPA 4), an estimated 48% of residents live below the federal poverty level and 8% report being homeless at least once in the last 5 years.

These families do not make enough money to cover rent and food each month and cannot afford the added cost of childcare. With limited alternatives and very little income, children are left alone for many hours without adult supervision while their parent(s) work and/or look for sustenance and work.

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BACKGROUND INFORMATION & RAPID RESEARCH METHODOLOGY

II. BACKGROUND INFORMATION

III. RAPID RESEARCH METHODOLOGY

Central City East, formerly referred to as “Skid Row” is located in downtown Los Angeles. It is a 50-block area bounded by Third Street on the north, Alameda Street on the east, Seventh Street on the south and Main Street on the west. The area is populated with a large number of homeless residents.

1. PROFILE OF WOMEN AND CHILDREN

“Skid Row” is polluted with trash and debris on the streets and sidewalks.

Although portable toilets are available, the area smells of urine and body odor. In recent years, the number of encampments (tents and cardboard box houses) has decreased.

However, they are still a familiar part of the Central City East landscape.

Transients normally gather on the streets and loiter during the daytime.

The most common areas are directly in front of the missions located in the area. The majority of the homeless carry their belongings in garbage bags and only a few push shopping carts. During the evening hours, the mission emergency shelters are full with transients seeking a place to sleep.

The Service Planning Area 4 (SPA 4) Area Health Office created a rapid assessment tool to assess the prevalence of women and children in Central City East. The purpose of this assessment was to more accurately describe this population and provide the SPA 4 Management and field Public Health Nurses with a more accurate picture of the women and children on “Skid Row” aimed to develop strategies to improve their health status and wellbeing.

In June 2003, a survey of 52 families living in temporary housing in Central City East was conducted totaling 106 participants. The survey comprised of the traditional Public Health Nursing (PHN) Assessment Form and 14 questions about quality of life specifically developed for this project. These questions inquired basic demographic information not collected by the PHN form and information about experiences while living in shelters or missions. No sensitive nature questions were included; however, participants were informed about their right to refuse to answer any question.

Each survey question was read aloud to participants to avoid illiteracy issues. The administration of the survey took approximately 20 to 30 minutes for each family, depending on the number of family members.

2. SHELTER/CHILD CARE FACILITY PROFILE Additional surveys were created to assess the capacities of shelters and childcare facilities in the Skid Row. Questions were developed to gain an understanding regarding the enrollment policies of shelters and childcare facilities, basic demographics of clients and staffing at these facilities.

A total of 3 facilities were surveyed -Union Rescue Mission, Ford Hotel and Para Los Niños.

Facts About the Homeless Population in Los Angeles: Approximately 82,000 people are homeless on any given night in Los Angeles County.

Homeless people may be found throughout the county, the largest percentages are in South Los Angeles and Metro Los Angeles (SPA 4) .

The average age is 40 - women tend to be younger.

33% to 50% are female. Men make up about 75% of the single population.

About 42% to 77% do not receive public benefits to which they are entitled.

20% to 43% are in families, typically headed by a single mother.

An estimated 20% are physically disabled.

41% of adults were employed within last year.

About 25% are mentally ill.

As children, 27% lived in foster care or group homes; 25% were physically or sexually abused.

33%-66% of single individuals have substance abuse issues.

48% graduated from high school; 32% had a bachelor degree or higher (as compared to 45% and 25% for the population overall respectively).

Institute for the Study of Homelessness & Poverty at the Weingart Center, June 2000

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FINDINGS AND RESULTS

IV. FINDINGS AND RESULTS 1. OVERALL The overall racial composition of those who completed the survey was as follows: 45.3% Hispanic, 40.1% African American, 3.8% White, and 7.5% unknown (Figure 1). Specifically, adults surveyed, reported being African American 51.8%, Hispanic 17%, White 4%, and 5% did not answer (Figure 2). This distribution was much different than the ethnic composition of Metropolitan Los Angeles (SPA 4 ) where 55% are Hispanic, 22% White, and 6% African American (Figure 4). The reasons for this discrepancy could not be determined due to the limitations of the survey. The median age of adults surveyed was 39.5 years ranging from 21 to 72 years. The majority of participants were single (69.6%) and 12.5% were married.

Women with children comprised of 40.4% of those surveyed and had an average of 2.7 children. The average length of stay in the shelters was 6.9 months. The average monthly income of adults was $191.00. Sources of income included, but were not limited to, AFDC (12%), government relief (23.2%), and supplemental security income (17.9%).

Figure 1. Racial Composition of Survey Participants (all)

Figure 2. Racial Composition of Survey Participants (adults)

The characteristics of the children living in Central City East vary greatly from the adults. According survey findings, children living Skid Row were predominantly Hispanic (64%) and 30% were African American (Figure 3, page 7). None of the children surveyed were White. The average age of the children was 6 years and 56% were female (Figure 5, page 8).

The majority of children had health insurance (82%) and 54% had a primary care physician.

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FINDINGS AND RESULTS

2. SHELTER/CHILDCARE FACILITIES

Figure 3. Racial Composition of Survey Participants (children)

2.1. UNION RESCUE MISSION Union Rescue Mission (URM), founded by Lyman Stewart, President and Founder of the Union Oil Company, first opened its doors in 1891. URM is a 750-bed shelter located in Central City East at 545 South San Pedro Street. This shelter is the largest Christian Rescue Mission in the United States and houses over 230,000 people annually. URM is the only emergency shelter in Los Angeles that is open 24 hours per day, every day of the year. Additionally, it is the only shelter in Los Angeles that accepts women and children without restrictions on the age or number of children. Mothers with sons up to and including 17 years of age are housed in the women/children emergency shelter. Males age 18 years and older are placed in the men’s shelter.

The shelter was home to approximately 107,000 women, children and families in 2002. This represents 46% of the overall resident population at the shelter. Currently, 118 children reside at URM. The average length of stay for tenants is 6 months to 1 year and more than 195,000 women and children were served meals at this facility in 2002. The URM management and staff have seen many changes in the clientele over the last several years. For example: (a) an increase in the number of Hispanic homeless, (b) an increase in the number of African American families with small children, and (c) an increase in the number of single women. Additionally, an increase in upper respiratory infections, rashes, and ear and throat infections has been seen among children in residence.

Figure 4. Racial Composition of SPA 4 Residents

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FINDINGS AND RESULTS

2.2. THE FORD HOTEL

2.3. PARA LOS NIÑOS

The Ford Hotel/Shelter is a six story Single Residence Occupancy (SRO) building with 288 rooms and 48 rooms on each floor. At the present moment, 260 rooms are occupied.

Each room has a window, concrete floors, a bed, a sink and a dresser.

Some rooms are equipped with extra furniture to accommodate additional children. The rooms in this facility are not equipped with bathrooms, kitchens or refrigerators; however, residents are allowed to bring their own refrigerator. No food services are available to the residents and there are a few vending machines that dispense chips, candy and soda on the 1st floor. Clients are required to complete an application, provide proof of income and present a valid California ID in order to secure a room in this facility. Room rates vary and are determined by the size of the family. A basic, single occupancy room starts at $125.00 per week with an additional $5.00 rental fee. The rate does not change if the room is rented by the month versus by the week. Residents at the Ford Hotel/ Shelter are families with and without children, single women and single men. An estimated 90% of the residents are families with children averaging 3 to 4 children per family.

There are over 180 children residing in this shelter. Residents live in this hotel for 1 to 2 years. Most of these residents are currently on the waiting list for Section 8 housing which, as mentioned above, consists of 120,000 families and an average wait time of 8 years.

Para Los Niños is a low cost/no cost day care facility located in downtown Los Angeles. This facility provides childcare services to families that live in the downtown Los Angeles. Most families are extremely low income and can not afford child care costs.

During the last fiscal year, 98.7% of clients had incomes below the poverty line --average monthly income below $1,100 for a family of four.7 In order for children to enroll in this facility, parents must be working and/ or receiving training or schooling and must provide income tax verification.

For most families, enrollment at Para Los Niños is free; however, some pay between $2.00 and $6.90 per week per child. Financial aid is available to families who are unable to pay this out of pocket. The children must be current on all immunizations and must have a social security number, physical exam, and a current tuberculosis test.

Para Los Niños enrolls a maximum of 120 children and is at maximum enrollment. The teacher/child ratio is fairly low at 1:3 for infants, 1:4 for toddlers and 1:8 for both early preschool and preschool. The majority of the children in attendance are between 3 and 5 years of age (80%). All of the children currently enrolled are Hispanic and the male to female ratio is 1:1. Children who enroll at Para Los Niños are given 2 meals per day (breakfast and lunch) and an afternoon snack. In addition to offering low cost/no cost childcare, this day care facility offers other services to its clients such as referrals to social services, case management, legal assistance, housing assistance, parenting classes, child abuse prevention, mental health services and advocacy support.

Additionally, food, clothing, tokens, and vouchers are available to client families.

Figure 5. Gender of Children Surveyed.

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DISCUSSION AND RECOMMENDATIONS

V. DISCUSSION AND RECOMMENDATIONS As previously described, Central City East, formerly known as “Skid Row”, is a 50-block area in downtown Los Angeles characterized by the presence of large numbers of homeless people. Not long ago, it was difficult to find women and children in Central City East. Although men still make up the majority of the homeless population, women with children is the fastest growing population group of homeless people.6 The women and children who were surveyed would benefit from interventions, services, agencies targeting solely their issues and concerns. Programs, services and resources for domestic violence prevention, financial management, job skills and training, health education, mental health and substance abuse counseling, childcare, and parenting are needed. If the current trend continues, an increase in the numbers of women and children is expected in Central City East.

The homeless population in the United States is one of great diversity and fluidity. It is important that agencies devoted to provide services and resources to the homeless population understand that risk factors for homelessness and the people themselves vary from geographic area to geographic area. The development of programs based on broad perspectives of homelessness may not provide a real benefit to this population. In addition, the notion that a single organization can meet all of the needs of this population is inappropriate and true, strategic alliances and partnerships

between public, private and non-profit agencies are needed to (1) strengthen, expand and diversify programs and services, (2) generate adequate financial resources to address specific social and health issues, (3) escalate efforts to prevent the growing homelessness trend among women and children, (4) make a real impact on the state of the homelessness in Central City East and (5) improve the health status and wellbeing of the homeless.

REFERENCES 1. State of California Department of Labor website. http://www.calmis. ca.gov 2. Reeve T. Schley. “Poverty on Rise Here.” Santa Monica Mirror. 8 July 2003.

3. 2003 Federal Poverty Guidelines 4. Los Angeles County Housing Authority. Telephone interview conducted by author. 20 June 2003.

5. Paul Tepper, Jessica Barrett Simpson and Eva Johnson, Poverty in Los Angeles, Institute for the Study Homelessness and Poverty at the Weingart Center (Los Angeles).

6. The Good Samaritan Crisis Model Network for Women with Children. http://www.helpforwomen.org/ statistic.htm 7. Para Los Niños website. http:// www.paralosninos.org 8. Union Rescue Mission website. http://www.unionrescuemission.org

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San Gabriel Valley Service Planning Area (SPA 3) Metropolitan Service Planning Area (SPA 4) 241 North Figueroa Street, Room 312 Los Angeles, California 90012 Tel: (213) 240-8049 Fax: (213) 202-6096 www.lapublichealth.org Š 2003 SPA 3 & 4

Assessing the Prevalence of Women and Children in SKID Row: SPA 3 & 4 Profile

June 2003