For the past four years, I worked for 801 East Shelter/Transitional Rehabilitation Program in many roles and completed more than 500 intake interviews/screenings. I observed a majority of those individuals had co-occurring disabilities, i.e., substance abuse and mental health issues. Having interned for Madison House Autism Foundation, I have looked back to those intake sessions and think differently about autism and homelessness:
1. Front-line emergency shelter staff may misconstrue autism as a mental illness.
One-third of the total homeless population is believed to have untreated serious mental health challenges (Office of Public and Research Affairs, 2016). According to the 2015 Housing and Urban Development survey 24% (104,083) of the total 436,921 adult homeless population were reported to have severe mental illness. Emergency shelters and transitional housing are designed to provide temporary harbor for people experiencing homelessness. Afterwards, the goal is to transfer them into permanent housing or rapid re-housing settings.
Front-line staff, including security officers, intake specialists, shelter monitors, case aids, and case managers may infer that a homeless person in crisis may only have a mental illness and not a developmental disability. Adding to the confusion is past medical professionals diagnosing children with childhood schizophrenia when today, they may likely be diagnosed as autistic. Now, when these adults are asked if they have ever been diagnosed with disability, they may respond with schizophrenia when they actually are on the autism spectrum.
Often, the results are less than optimal support, accommodations, and responses because of the lack of staff training about autism and their misappropriation of diagnosis.
2. Front-line emergency shelter staff do not have adequate autism identification and sensitivity training.
From my experience, it was not uncommon to see front-line shelter staff treat people on the autism spectrum like clients with mental health challenges instead of clients with neurological/neurodevelopmental disorder. The staff was unaware how to best identify and support autistic clients through the intake process. I never received any autism-specific training while working as intake person, just general training that focused on mental health challenges. Some of the trainings that I completed include:
- Rights under the American with Disabilities Act/Reasonable Accommodation,
- Customer Service & Language Access,
- Understanding Special Needs, and
- Characteristics of Populations served.
These trainings highlight the individual’s rights and access to information, but do not include the accommodations for ‘invisible’ disabilities common to people with autism, i.e., social skill challenges, sensory overload, support to prevent meltdowns, etc.
To access a bed in the shelter, all shelter residents (autistic adults included) must go through a processes which involves filling out a text application, going through a verbal intake (if new to the shelter), linen/bedsheets reception, and bed assignment. Shelters admit residents on a first-come, first-served basis. These processes can be challenging for someone on the autism spectrum for the following reasons:
- Residents are supposed to line up before the shelter opens, and this is where security officers are in charge of maintaining order and safety. Residents can not move from their place if it’s too loud, smelly or scary because they risk losing their spot. What if this causes a meltdown? How would the security officers react?
- Residents must also get searched by security officers and have their bodies patted down. Many people on the spectrum are sensitive to a loved one’s touch, let alone a security officer who may touch them in ways that are hard to endure.
- Their belongings are taken from them and must be passed through security metal detectors. Some individuals on the spectrum hold items that may seem odd as an object of security, stability or comfort. They may not be willing to let go of those belongings and shelter staff will label these individuals non-compliant.
- Shelter monitors may issue instructions one after the other to autistic adults. This barrage of verbal commands may be too much to process and cause the person the spectrum to shut down or flee. The same reaction could occur when handed a form to fill out as reading, writing or answering text-based questions can sometimes be challenging.
3. Demonstrating disability or self-advocating may be difficult for homeless autistic people in emergency shelters.
After homeless individuals go through front-line intake process, they must request to get additional help. The 801 East Emergency Shelter is a low-barrier shelter program, open to anyone, and offers dinner, access to management staff, showers and a bed on a nightly basis. Of the more than 400 beds, the program mostly provides shelter to people with disabilities. Typically, residents must seek help and disclose their disabilities to access additional services. Individuals can not stay in the shelter during the day unless they are in a “work-bed” program. Thus, caseworkers typically spend their time with working clients while other residents leave the shelter for the day.
Some researchers contend that homelessness could be correlated with loss of employment, low level of educational achievement, economic factors, poor health and inability to access needed services, poverty and social exclusion, structural, personal and political factors. These are all factors that people on the autism spectrum or who have other intellectual developmental disability (I/DD) experience due to their impairment or being disabled by society. They may not know how to self-advocate or understand that they may be able to access additional services by disclosing their disability.
Use of autism screening tool at intake by a well trained staff might help identify people on the autism spectrum and make transition to services beyond the shelter easier. For instance, front-line staff could use this fast and easy screening questionnaire.
4.Connecting shelter residents on the autism spectrum to additional services and supports may allow these individuals to leave the shelter system
Often, homeless people could be invisible and ignored on the streets unless they are linked with social service providers. Going through the intake process at a homeless shelter may be a barrier to access for many autistic adults, but for those who make it through the process and are identified as being on the autism spectrum, can they obtain the help they need?
Case managers are often available on-site to help the residents and refer eligible clients to social service providers. Case managers have had Supplemental Security Income (SSI)/Social Security Disability Insurance (SSDI) Outreach, Access, Recovery (SOAR) training to refer and link eligible clients to nearby Social Security Administration office. However, these managers may be unfamiliar with access to services through the state’s developmental disability agency if their experience is primarily in the mental health field.
A customized intake tool-kit and well-trained staff who could communicate well with people on the spectrum could greatly assist homeless autistic adults to find affordable housing and support services to better integrate and thrive in their community.
5. There is no data collection on homeless autistic adults in emergency shelters.
It is impossible to tell the exact number of the autistic homeless population residing in emergency shelters or sleeping on the streets. “Point in Time” is the most critical census tool employed in shelters and transitional housing. On a single night in January, volunteers walk sections of a neighborhood or city to determine the total number of homeless population. Last year in 2016, some 549,928 people were estimated to be homeless in a single day based on point-in-time counts (U.S. Department of Housing and Urban Development, 2016). 68% were staying in emergency shelter, transitional housing or safe haven during this period according to the same report. Thus, 32% were sleeping on the street.
“Point in Time” is thought to provide comprehensive data. However, with a closer look at the content of the survey, one can challenge comprehensiveness. The survey includes some disability-related questions, i.e., disability type, determination, duration, documentation, confirmed status, current treatment status, and long-term status.
“Developmental disability” is an option, but the survey does not specify the diagnosis of autism as an option. Additionally, the responses are simply self-reported from the homeless individual. If individuals do not know what a “developmental disability” is, they will not know to respond with ‘yes’ if they were diagnosed with autism, learning disability, ADHD, etc.
Additionally, not every jurisdiction uses the same tool. For example, the ”2017 Point in Time” report by the Community Partnership for the Prevention of Homelessness in Washington DC did not collect data for adults with developmental disabilities in 2016.
A data collection mechanism can measure the prevalence of autism in the homeless population. With a simple addition of types of I/DD to choose from either in the Point in Time survey or intake initial assessment form, we can calculate the number of autistic adults in the shelter and provide appropriate supports.
I hope that research will be conducted to answer the following questions:
- How many people experiencing homelessness are autistic or have another I/DD?
- What kind of services is provided to homeless people on the autism spectrum, given their vulnerability as a result of having the difficulty of communicating and lack of social skills, among others?
- Are staff who give direct service to autistic adults (Intake specialist, Case manager, Addiction Counselors, Residential Counselor, Shelter Monitors, Case Aids) trained and informed on autism and related issues?
- How can a shelter offer reasonable accommodation services for homeless autistic persons with social and communication challenges when the request is supposed to be made by the people with social and communication difficulties?
It is essential that front-line staff in emergency shelters identify and communicate with autistic homeless clients. By doing so, autistic adults may equally participate in the shelter program and beyond. Effective communication among intake specialists, case managers, and shelter monitors/residential counselors is a vital step. Effective communication occurs through continual autism training. The-already-in-place collaborative partnership with other governmental or not-for-profit entities can implement autism training. Shelters may be doing what they can in providing immediate harboring to autistic homeless people. However, concerted efforts by concerned people and entities should be there to make the world a better place where every individual counts.