Enhanced Methodologies to Enumerate Persons Experiencing Homelessness in a Large Urban Area

Introduction: Homelessness is a public health problem, and persons experiencing homelessness are a vulnerable population. Estimates of the number of persons experiencing homelessness inform funding allocations and services planning and directly determine the ability of a community to intervene effectively in homelessness. The point-in-time (PIT) count presents a logistical problem in large urban areas, particularly those covering a vast geographical area. Materials and Methods: Working together, academia, local government, and community organizations improved the methodology for the count. Specific enhancements include use of incident command system (ICS), increased number of staging areas/teams, specialized outreach and Special Weapons and Tactics teams, and day-after surveying to collect demographic information. Results: This collaboration and enhanced methodology resulted in a more accurate estimate of the number of persons experiencing homelessness and allowed comparison of findings for 4 years. While initial results showed an increase due to improved counting, the number of persons experiencing homelessness counted for the subsequent years showed significant decrease during the same time period as a “housing first” campaign was implemented. The collaboration also built capacity in each sector: The health department used ICS as a training opportunity; the academics enhanced their community health efforts; the service sector was taught and implemented more rigorous quantitative methods; and the community was exposed to public health as a pragmatic and effective discipline. Practical Implications: Improvements made to increase the reliability of the PIT count can be adapted for use in other jurisdictions, leading to improved counts and better evaluation of progress in ending homelessness.