Ending Rural Homelessness: Advice from Experts in the Field

USICH spoke with two providers, Dreama Shreve of the Appalachian Regional Coalition to End Homelessness and Dr. Tom Simpatico of Pathways to Housing Vermont and the University of Vermont, on the nature of homelessness in rural areas and ways to improve services. 

What Everyone Should Know about Rural Homelessness: An Interview with Dreama Shreve

Dreama Shreve is the Executive Director of the Appalachian Regional Coalition on Homelessness (ARCH). ARCH is a rural continuum of care, made up of 40 agencies and over 200 churches that collaborate on data collection and data sharing. This coalition has succeeded in pulling eight counties and three small cities, which are located in mountainous Appalachian terrain and cover 1,243 square miles, into a regional service area that responds as a unit. 

USICH: How would you describe rural homelessness to someone who may only understand homelessness as an urban problem?  

Shreve: The differences span multiple barriers. Transportation is a key difference, as towns in rural areas, and homeless individuals as a result, are sprawling rather than centralized. People who are impoverished need a car and gas to access service providers and other social services. If these individuals do not have a car (which is common), services need to be brought to them.

Access to education is also an issue that is magnified in rural communities. Youth tend to live far from local schools. Schools and faculty are also usually under resourced. Family life can also encourage students to drop out. If a student is able to find a job, they are likely to drop out of school to provide for the rest of the family. 

The threat of domestic violence is an important factor in the regions where ARCH provides services. With financial dependency on their male partners, women can often be forced to choose between homelessness and a violent home life.

The greatest differences between rural and urban homelessness continues to be the gap in employment and availability of suitable housing. Rural communities have even fewer jobs, due to underdeveloped industry, and even fewer homes available for occupancy.

USICH: What needs to be done better? 


Transportation: there is limited to no public transportation in rural communities. What public transportation that does exist ends at 5PM. Public transportation funding is desperately needed when individuals in these communities are typically traveling around an hour to get to work every day. This investment will also enable individuals living in poverty to get to service providers in larger towns. 

Rural areas need more industrial development. The nurturing of young entrepreneurs and business owners will create and sustain new jobs. Universities could be used as a resource to start employment co-ops and career centers. Unfortunately, most large manufacturers cannot locate an office, headquarters, or retail chain in rural areas because it is so far from the interstate. Innovation needs to occur so as to establish local business through entrepreneurial ventures. People are full of ideas but they have no means, no connections. We need to work together to get a vehicle for those means to come to rural areas. 

The housing stock in rural communities is vastly different from urban communities and needs to be upgraded, or new housing needs to be developed. Rural areas have a lot of open land but there is an absence of apartment buildings. Of the housing that does exist, it often would not pass inspection, because landowners cannot afford to upgrade their current housing. The problems that do exist are extremely hazardous for residents: some homes do not have proper sewage; they may have well water which may or may not be reliably clean. The first step should be to get existing housing up to code, and then work to create more rental units.

USICH: What are some of the unique strategies service providers in your area use to address the challenge of rural homelessness? 

Shreve: Due to the sprawling nature of rural homelessness, providers need to bring their services out to individuals and families experiencing homelessness. Service providers going out to communities provide a regular schedule of case management and treatment that is spread across the community. The community action agency typically has an office in each county, which serves as a central hub where providers can meet with clients, make referrals, and allow for greater access.  

USICH: What does the PIT count look like in your region? What improvements do you think need to occur?

Shreve: If you are in an urban setting, the timing of the PIT count makes sense. January typically has cold weather which funnels the majority of population into shelters, making them easier to count. However, in rural areas this is just not the case. Individuals and families experiencing homelessness cannot reach shelters; they are residing in caves in the woods, people’s barns or under houses. If we had the resources, we’d do a second count in April so we could compare the results. Folks are out and about, able to walk and get around. Individuals experiencing homelessness in rural communities are much more transient, and unless you know where they are, you are much less likely to encounter them. 

Urban Best Practices in a Rural Context: Housing First Works
An Interview with Tom Simpatico

Dr. Tom Simpatico is Director of the Division of Public Psychiatry at the University of Vermont’s College of Medicine, and Director of the Integrative Care Management Institute at the UVM Center for Clinical & Translational Science.  He serves as Medical Director for Pathways to Housing Vermont and as Director of Psychiatric Services for the Vermont Department of Corrections.

Pathways to Housing Vermont opened in January 2010 in Burlington, and opened their second office in Montpelier in July of that year and a third satellite in Brattleboro soon thereafter. Funded by grants from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Vermont State Department of Corrections (DOC), the Pathways Team works to find permanent and independent housing for individuals experiencing chronic homelessness, many with alcohol and substance use disorders. Since 2010, Pathways Vermont has housed more than 70 individuals experiencing chronic homelessness in communities around Vermont. USICH spoke with Dr. Simpatico on the subpopulations he has identified in rural communities and their needs. He also then details the ways in which the Pathways to Housing model has been adapted for Vermont’s rural environment.

USICH: From your research and experience, what are some of the subpopulations of rural Americans experiencing homelessness? 

Dr. Simpatico: The nature of rural communities often obscures the homeless population.  Unlike urbanized areas, rural communities seldom have in place a formal social service network that would facilitate measuring the problem. 

To the best of our knowledge, some of the subpopulations of people experiencing homelessness in rural and frontier areas include the following:

  • The Traditional Homeless - people living unsheltered on the street, the characteristics are similar to people experiencing chronic homelessness in urban areas. They often suffer from substance abuse, personal tragedy, or mental or physical disabilities.  They generally have had little recent attachment to the labor force and have trouble maintaining a permanent address or securing employment. 
  • The Working Poor - often driven by financial hardship, this group has been growing in recent years.  They are often one- and two-parent families with children.  They often double-up with friends/friendly acquaintances and/or move frequently in search of work.
  • Displaced Farmers and Farm Workers - farm foreclosures cause displacement for many who rely on farms for work and livelihood. Since it is often difficult to resell property after foreclosure, farmers are often permitted to stay on the land.  There is often despondency involved as farms have been in a family’s possession for generations; there is a sudden loss of personal identity as well as financial security. 
  • Veterans - Veterans are more likely to live in rural areas than other households and Veterans in rural areas tend to be older and in worse health than Veterans in urban areas.  Because rural Veterans experiencing homelessness are not easily identifiable and not engaged in services, it is difficult to capture an accurate picture of the number of Veterans experiencing homelessness in rural communities. However, we will most likely see an increase in the number of younger Veterans living in rural areas. In 2008, Rand Corporation reported that since October 2001, almost 1.64 million U.S. troops have been deployed for Operation Iraqi Freedom (OIF; Iraq) and Operation Enduring Freedom (OEF; Afghanistan). The report highlighted the invisible wounds of war, relating to the psychological aftermath of these military initiatives. The two main invisible psychiatric and neurological areas of concern were post-traumatic stress disorder (PTSD) and traumatic brain injury (TBI). We will need to ensure that Veterans in rural areas can access reliable behavioral healthcare if we are to address these issues. 

USICH: Can you tell me a little about the Housing First/Pathways to Housing Model? How does the model work and how is it adapted for Vermont?

Dr. Simpatico: The Pathways to Housing Housing First Model is relatively simple: provide housing first, and then combine with supportive services encompassing the areas of mental and physical health, substance abuse, employment, and education. Typically, in urban areas, the housing is provided in apartments scattered throughout the community. In cities, the model has been effective in addressing chronic homelessness. The people who created Pathways to Housing came to me at the University of Vermont to see how the model would work in a rural setting. The typical urban model would not work as well since the rural population is geographically spread out and access to a strong and established social service network is not available.

To be adapted for a rural setting, what Pathways Vermont has done is use technology to create a virtual version of the urban model. The individuals receive the services, aided by technology, after the initial outreach has been made. All it takes is connection to one social service organization and much of the rest can be done virtually with other organizations and housing providers. Recipients still have access to specialists and case management; however, in the rural setting they are using refurbished computers to do video visits. When clients have access to computers, frequent contact occurs between individuals and service providers. Service providers in the Pathways network have also been outfitted with refurbished iPhones and laptops which allows for greater communication between teams. These organizations have even been able to use advanced features on Google+ to have conference calls with one another and with clients so they can coordinate services and transitions to housing at the same time. Technology is an important tool to bridge the void and compensate for the distances between service providers and clients, especially when there is not a strong public transportation system. 

USICH: What should policymakers know about rural homelessness and how best to address it?

Dr. Simpatico: Rural homelessness is less conspicuous. Homelessness is a very real part of the urban landscape. It is much harder to see something that conspicuous in a rural setting. Rural homelessness is often misrepresented, falling under the rubric of “quaint” or “simple.” Policymakers should not fall into complacency, thinking homelessness does not exist in a rural or frontier setting. It may not be as obvious but it still requires our attention.