Los Angeles is arguably the capital of homelessness in the United States. Recent studies have found that on any given day, nearly 50,000 people are living on the streets of Los Angeles County—including 4,200 youth and 6,500 veterans.

Along with an increase in supportive housing, effective and proven interventions are desperately needed to address the myriad issues plaguing the homeless population: drug and alcohol abuse, violence, sexual assault, disease, and a general lack of shelter, food, and vital resources.

A newly formed core of researchers at the Hamovitch Center for Science in the Human Services is focusing its efforts on those very topics.

Backed largely by funding from the National Institutes of Health, faculty researchers are engaging in pilot programs, clinical trials and qualitative studies in pursuit of a singular goal: developing better methods to help those living on the streets to escape poverty.

"We're all working for the same good cause," said Suzanne Wenzel, a professor with the USC School of Social Work who has devoted much of her career to understanding the health needs of homeless populations.

Wenzel is joined by associate professors Seth Kurzban, Eric Rice and Kristin Ferguson, a group that has formed the nucleus of homelessness research at the Hamovitch Center.

While their interests are varied—Wenzel and Kurzban tend to work more with homeless adults, while Rice and Ferguson focus on youth living on the streets—the researchers are slowly building the center's reputation as a hub of inquiry into the lives and circumstances of homeless people.

"If you want to do this kind of work, there's really no better place to be," Rice said. "We should become known as the place where this is happening."

Surveying the social terrain

In her pursuit of effective solutions to the health-related issues of homeless people, Wenzel has conducted studies on the relationship between trauma, substance abuse and HIV/AIDS risk among homeless women; examined the social context surrounding similar risk factors among homeless men; and developed programs to treat post-traumatic stress disorder and prevent victimization, risky sexual behaviors and substance abuse.

The Hamovitch Center's proximity to downtown Los Angeles, and particularly Skid Row—about 50 square blocks that contain one of the largest stable populations of homeless people in the country—has proven useful to Wenzel as she examines health risks among the homeless population.
"The downtown metropolitan area of Los Angeles is a hot spot for HIV infection," she said, noting that Skid Row itself has a disproportionately higher rate of HIV and AIDS than surrounding areas.

Higher levels of alcohol and drug use tends to lead to risky behavior, she explained, but the general state of poverty and lack of access to resources leads to a greater risk of exposure. Homeless adults tend to be more worried about finding shelter and food, and avoiding violence, than protecting themselves from sexually transmitted diseases, Wenzel said.

"A homeless woman might be trading sex to survive, and she's not going to get as much money if she makes the guy use a condom," she said.

Delving into that social context is the objective of two grant-funded studies she is currently pursuing—a $362,151 grant from the RAND Corporation and the National Institute of Drug Abuse to examine the context surrounding alcohol and drug use among impoverished women and their decisions to engage in risky or protective sexual behaviors, and a $1.97 million grant from the National Institute of Child Health and Human Development to study the social and gender-based determinants of heterosexual homeless men's sexual behavior.

Wenzel said she is hopeful both studies will inform future research and enhance interventions to reduce HIV risk among homeless adults.

Early intervention

Rice, who joined the Hamovitch Center in 2009, is also interested in the interplay between social networks and HIV risk, but within a younger population. Working closely with community-based organizations, he has connected with teenagers and young adults living on the streets, a passion that grew from a stint as a volunteer at a drop-in center in Hollywood.

"The great thing about working with homeless youth is there's a sense of hope," he said, explaining that if social work practitioners intervene correctly, their clients stand a good chance of getting their lives back on track. "If you see the hopefulness in it, you're hooked."

Using a $447,646 grant from the National Institute of Mental Health, Rice is examining the effectiveness of interventions that seek to reconnect young homeless people with positive influences in their lives. Through in-depth interviews and a mapping technique that sketches out the social networks of homeless youth, he has confirmed that those doing better had a close friend from home, a caring family member or a mentor of sorts looking out for them.

"When you have kind of a tether to the world outside of street life, that can really promote more healthy behaviors," he said.

Rice plans to follow a group of young homeless people in Hollywood and Santa Monica for two years to examine how their interactions change over time. He expects to gain keener insights into their social systems, leading to better interventions to nurture and support positive relationships.

Ferguson, who also works with homeless youth, is focusing her efforts on the social and spiritual aspects of street life. Her previous projects include an effort to identify best practices in faith-based organizations working with youth on the street in Los Angeles, Mumbai and Nairobi.

A $745,581 grant from the National Institute of Mental Health that runs through September 2011 has allowed Ferguson to pursue a pilot study to test the feasibility of employment support for youth with mental illness.

By integrating employment services with individualized clinical support, she hopes to create a program that helps street youth obtain competitive employment at two drop-in centers in Hollywood.

Participants who complete the training program will help operate a small business, with the goal of replacing any street earnings with comparable income. The two-year grant builds on a previous pilot study that taught graphic design skills to homeless youth, along with marketing and accounting practices.

Kurzban is also pursuing interventions that aid individuals dealing with severe and persistent mental illness, as well as chronic homelessness, incarceration and substance abuse. He is currently testing a program to reduce social isolation and improve self-care and wellness among homeless adults.

As a post-doctoral fellow at USC, Kurzban received a Larson endowment to adapt the intervention for use at a county mental health clinic with women suffering from mental illness who are returning to their community after being released from jail.

Building alliances

Key to the researchers' success is meaningful interaction and involvement with community-based organizations and service providers. Reflecting the Hamovitch Center's innovative focus on translational research, they are developing strong ties to community groups and ensuring that programs and interventions are feasible options for social work practitioners.

A decade ago, Wenzel admits she didn't spend too much time worrying about how her research would translate into action on the streets. Now, developing best practices and understanding how the research-to-practice pipeline works is a significant factor.

"That collaboration is absolutely critical in improving the status of homeless people," Wenzel said.