Background: Skid Row is an impoverished neighborhood in Los Angeles, also known as the homeless capital of America. Those experiencing homelessness have compounding needs that are largely unmet by existing safety-net systems. The goal of this study is to evaluate the needs of homeless individuals in the Skid Row community, to better tailor services for the homeless population residing in the area. For the study, the International Collegiate Health Initiative (ICHI), a 501(c)-3 nonprofit based in the University of California, Los Angeles, conducted a community needs assessment and a review of the literature regarding community-based solutions to addressing unmet needs of this population. 

Methods: This study uses a cross-sectional survey approach to conduct a community needs assessment. We included yes or no answers, numerical responses, and open-ended question response types. The questions contained questions regarding age, demographics, drug use, medical service use, benefits received, and needs. For data collection, ICHI team members conducted surveys of adults residing in Skid Row on three separate days. A total of 163 adult individuals responded to our survey. We conducted a descriptive analysis of data from our needs assessment surveys, and examined the data to inform how services would be tailored for this community.

Findings: Survey findings reveal unmet health, social, and employment needs among unhoused individuals in Skid Row. Over 80% of individuals who took the survey self-identified as homeless and over 75% were seeking housing. Over 75% of the homeless individuals surveyed reported having insurance, with the most common health insurance provider being MediCal. Over 75% of individuals surveyed are interested in accessing health screenings. There was a high unemployment rate, with over 45% of respondents currently seeking employment, and over 80% would consider themselves struggling financially. Mental health struggles are prevalent, over 40% of individuals self-reported they experience struggles with their mental health.

Conclusions: There is potential to meet the needs of the unhoused population through various community efforts and public health interventions. Service priorities for mental health care, medical care, and employment services, are corroborated by prior literature that identifies high mental health issues, substance use, and underemployment.

References:

1. Henry M, de Sousa T, Roddey C, et al. The 2020 Annual Homeless Assessment Report to Congress. The U.S. Department of Housing and Urban Development. 2021 Jan.
2. The Council of Economic Advisers. The State of Homelessness in America. National Homeless Information Project. 2019 Sep.
3. United States Interagency Council on Homelessness. California Homelessness Statistics. 2020.
4. Los Angeles Homeless Services Authority. 2020 Greater Los Angeles Homeless Count—City of Los Angeles. Los Angeles, CA. 2020 Jul 29.
5. Baggett TP, O’Connell JJ, Singer DE, et al. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010 Jul;100(7):1326-33. 
6. Yu W. Homelessness in the U.S., California and Los Angeles. Anderson School of Management. 2018 Jun.
7. Los Angeles Homeless Services Authority. 2020 Greater Los Angeles Homeless Count—Skid Row. Los Angeles, CA. 2020 Jul 30.
8. Teruya C, Longshore D, Andersen RM, et al. Health and health care disparities among homeless women. Women Health. 2010 Dec;50(8):719-36. 
9. Dawson A, Jackson D. The primary health care service experiences and needs of homeless youth: a narrative synthesis of current evidence. Contemp Nurse. 2013 Apr;44(1):62-75.
10. Hamilton AB, Poza I, Hines V, et al. Barriers to Psychosocial Services among Homeless Women Veterans. J Soc Work Pract Addict. 2012 Jan 1;12(1):52-68. 
11. Nyamathi A, Salem BE, Shin SS, et al. Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults. Nurs Res. 2021 Nov-Dec 01;70(6):433-442.
12. Feldman BJ, Kim JS, Mosqueda L, et al. From the hospital to the streets: Bringing care to the unsheltered homeless in Los Angeles. Healthc (Amst). 2021 Sep;9(3):100557.
13. Green HD Jr, Tucker JS, Golinelli D, et al. Social networks, time homeless, and social support: A study of men on Skid Row. Netw Sci (Camb Univ Press). 2013 Dec 18;1(3):305-320.
14. Garcia AP, Minkler M, Cardenas Z, et al. Engaging homeless youth in community-based participatory research: a case study from Skid Row, Los Angeles. Health Promot Pract. 2014 Jan;15(1):18-27.
15. Roberson J, Nardi B. Survival Needs and Social Inclusion: Proceedings of the 2010 ACM Conference on Computer Supported Cooperative Work. ACM Conferences. Association for Computing Machinery. 2010 Feb 1;445-448.
16. Kuo A, Los Angeles City Women’s Needs Assessment. Downtown Women’s Center. 2019
17. Rhoades H, Wenzel SL, Golinelli D, et al. Predisposing, enabling and need correlates of mental health treatment utilization among homeless men. Community Ment Health J. 2014 Nov;50(8):943-52.
18. Wang I, Dopheide JA, Gregerson P. Role of a psychiatric pharmacist in a Los Angeles “Skid-Row” safety-net clinic. J Urban Health. 2011 Aug;88(4):718-23. 
19. Collins B, Loukaitou-Sideris A. Skid Row, Gallery Row and the Space in between: Cultural Revitalisation and Its Impacts on Two Los Angeles Neighborhoods. Urban Displacement Project. 2016;87(4):401-427.
20. Henwood BF, Redline B, Lahey J. Surveying Tenants of Permanent Supportive Housing in Skid Row about COVID-19. J Health Care Poor Underserved. 2020;31(4):1587-1594.
21. Tinland A, Loubière S, Boucekine M, et al. Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomized controlled trial. Epidemiol Psychiatr Sci. 2020 Sep 30;29:e169.
22. Garvin LA, Hu J, Slightam C, et al. Use of Video Telehealth Tablets to Increase Access for Veterans Experiencing Homelessness. J Gen Intern Med. 2021 Aug;36(8):2274-2282.