Homelessness: Appropriate Controls Implemented for 1990 McKinney Amendments' PATH Program (Letter Report, 02/22/94, GAO/HEHS-94-82). The Department of Health and Human Services' (HHS) Projects for Assistance in Transition From Homelessness (PATH) program provides states with funds to serve homeless persons with serious mental illnesses and substance abuse problems. HHS has implemented appropriate program controls to ensure that PATH expenditures are consistent with the 1990 McKinney Amendments, which require GAO to report on the PATH program every three years. In the five states GAO reviewed--California, Florida, Illinois, New York, and Texas--state grant procedures, financial oversight, and provider monitoring also helped guarantee that PATH services reached the target population. Local providers' mental health assessments further ensured that PATH services reach the people they were intended for. --------------------------- Indexing Terms ----------------------------- REPORTNUM: HEHS-94-82 TITLE: Homelessness: Appropriate Controls Implemented for 1990 McKinney Amendments' PATH Program DATE: 02/22/94 SUBJECT: Disadvantaged persons Program evaluation Monitoring Indigents Internal controls Homelessness Mental illnesses Funds management Reporting requirements Eligibility determinations IDENTIFIER: California Florida Illinois New York Texas Tennessee HHS Projects to Assist in Transition from Homelessness Program Hurricane Andrew ************************************************************************** * This file contains an ASCII representation of the text of a GAO * * report. Delineations within the text indicating chapter titles, * * headings, and bullets are preserved. 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We are unable to accept electronic orders * * for printed documents at this time. * ************************************************************************** Cover ================================================================ COVER Report to Congressional Committees February 1994 HOMELESSNESS - APPROPRIATE CONTROLS IMPLEMENTED FOR 1990 MCKINNEY AMENDMENTS' PATH PROGRAM GAO/HEHS-94-82 Transition From Homelessness Abbreviations =============================================================== ABBREV CMHS - Center for Mental Health Services DSM-III-R - Diagnostic and Statistical Manual of Mental Disorders HHS - Department of Health and Human Services PATH - Projects for Assistance in Transition From Homelessness SAM-E - Systems Administrative Management Entity SAMHSA - Substance Abuse and Mental Health Services Administration Letter =============================================================== LETTER B-255718 February 22, 1994 The Honorable Edward M. Kennedy Chairman The Honorable Nancy L. Kassebaum Ranking Minority Member Committee on Labor and Human Resources United States Senate The Honorable Henry A. Waxman Chairman The Honorable Thomas J. Bliley, Jr. Ranking Minority Member Subcommittee on Health and the Environment Committee on Energy and Commerce House of Representatives On any given night, up to 600,000 Americans are homeless.\1 About one-third of the adults in this population have a serious mental illness. The Department of Health and Human Services' (HHS) Projects for Assistance in Transition From Homelessness (PATH) program provides the states and territories with funds to serve homeless individuals who are seriously mentally ill or dually diagnosed with serious mental illness and substance abuse disorders. The PATH program is authorized under the Stewart B. McKinney Homeless Assistance Amendments Act of 1990 (P.L. 101-645). Section 528(c) of the act requires us to report on the PATH program every 3 years. For this first report, we interviewed officials responsible for the program, reviewed documents, and visited two local providers. We specifically reviewed documents describing PATH program implementation in California, Florida, Illinois, New York, and Texas. (See app. I for more details on our scope and methodology.) This report provides information on (1) how HHS ensures that PATH expenditures are consistent with the 1990 McKinney Amendments and (2) how HHS and the states ensure that PATH funds reach the target population. As requested, it also provides information on how local providers assess the appropriateness of homeless individuals for receiving PATH services. In September 1993, we briefed your offices on the results of our work. As agreed, this report completes our initial work on the PATH program. -------------------- \1 M.R. Burt and B.E. Cohen, America's Homeless: Numbers, Characteristics, and Programs that Serve Them (Washington, D.C.: The Urban Institute Press, July 1989). Many factors, such as states' definitions of homelessness, and undomiciled and unstable living conditions, prevent federal and state officials from obtaining an accurate count on the number of homeless. For example, see 1990 Census: Limitations in Methods and Procedures to Include the Homeless (GAO/GGD-92-1, Dec. 30, 1991). BACKGROUND ------------------------------------------------------------ Letter :1 Assistance programs for the homeless under the McKinney Act, as amended, provide homeless people with emergency food and shelter, transitional and permanent housing, primary health care services, mental health care, alcohol and drug abuse treatment, education, and job training. From fiscal year 1991 through fiscal year 1993, Congress appropriated about $92.5 million for PATH, of which HHS granted about $90.7 million to the 56 states and territories to support specific services for the target population.\2 These services include outreach, screening and diagnosis, training and retraining of independent living skills, community mental health care, alcohol or drug treatment, staff training, client case management, client supportive and supervisory services in a residential setting, referrals for primary health care, job training, and educational services. In addition, a state may allocate up to 20 percent of its PATH grant for housing services and up to 4 percent of the grant for administrative expenses. The 1990 McKinney Amendments do not require each state to provide all of the eligible services. They also do not permit expenditures for emergency shelters, housing construction, inpatient psychiatric or substance abuse treatment, or cash payments to recipients of mental health services. States and territories must apply annually to HHS for PATH grants and provide year-end annual reports on clients and services delivered.\3 The PATH application asks the states for comprehensive budgetary and programmatic information on the states' planned local provider activities, as well as state-level implementation and oversight. As part of the application, states also must describe how they have coordinated planned PATH activities with the states' plans for comprehensive community mental health services.\4 The states must submit their year-end annual reports by January 31 to receive subsequent years' PATH grants. The annual reports include narrative and statistical reports on client services delivered. HHS awards PATH grants to the states according to a statutory formula based on a state's urban population. The 1990 McKinney Amendments require that HHS allocate to each state, the District of Columbia, and Puerto Rico no less than $300,000 and to each of the four territories--Guam, the Virgin Islands, American Samoa, and the Northern Marianas--no less than $50,000. Appendix II shows the funds allocated to states and territories for fiscal years 1992 and 1993. The amendments also require that states match PATH funds by providing $1 for every $3 of federal funds.\5 States award PATH grants to local providers that can be political subdivisions and/or nonprofit entities. Nationally, from fiscal year 1991 to fiscal year 1992, states reported an increase in the number of local PATH providers from 167 to 382 and the number of clients served from about 53,000 to about 98,000.\6 (See app. III for information on the number of clients served by states and territories for fiscal year 1992.) According to the states' annual reports, PATH funds accounted for 1.3 percent of the local providers' total budgets in fiscal year 1991 and 0.7 percent in fiscal year 1992. Similarly, PATH clients constituted a small percent of the local providers' client enrollments--11 percent in fiscal year 1991 and 8.4 percent in fiscal year 1992. Although PATH is a small portion of providers' budgets, it is important because it allows them to target services for a difficult-to-reach population. -------------------- \2 The remaining $1.8 million was used to fund the PATH program's technical assistance contracts. \3 Organizationally, the PATH program is administered by the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services. \4 Among other activities, this federally financed planning process requires states to develop community-based outreach and support services for chronically mentally ill individuals who are homeless. \5 Under HHS regulations, Guam, the Virgin Islands, American Samoa, and the Northern Marianas are not required to meet HHS' cash or in-kind matching requirements for grants and cooperative agreements requiring $200,000 or less as a match. \6 HHS' PATH Director estimates that the states' fiscal year 1993 data will closely resemble those from fiscal year 1992. RESULTS IN BRIEF ------------------------------------------------------------ Letter :2 HHS implemented appropriate program controls to help ensure that PATH expenditures are consistent with the 1990 McKinney Amendments. In the five states we reviewed, state grant procedures, financial oversight, and provider monitoring also help ensure that PATH services reach the target population. Local providers' mental health assessments further ensure that PATH services reach the target population. PRINCIPAL FINDINGS ------------------------------------------------------------ Letter :3 HHS IMPLEMENTED PROGRAM CONTROLS ---------------------------------------------------------- Letter :3.1 HHS' PATH program controls help ensure that the states use PATH grants to fund eligible services for the target population. The program controls include the annual grant application review process and the annual state reports. In 1993, the PATH program added on-site monitoring to its program control measures. APPLICATION REVIEW PROCESS -------------------------------------------------------- Letter :3.1.1 The PATH program has a three-step application review/follow-up process. First, grants management specialists use a checklist to review state budgets to ensure that they comply with the 1990 McKinney Amendments' 25-percent matching requirement and that PATH expenditures are within the housing and administrative cost limits. Second, a PATH program review panel of federal officials uses another checklist to identify unclear, incomplete, and inconsistent information in the states' applications. The Director selects review panel members based on their familiarity with the PATH program or the target population. Experts serving on the 1993 review panel represented the Department of Housing and Urban Development and HHS' National Institute of Mental Health, Center for Substance Abuse Treatment, and Health Resources and Services Administration, as well as the Center for Mental Health Services (CMHS) and the Substance Abuse and Mental Health Services Administration (SAMHSA). After the panel members complete and discuss their application review findings, the PATH Director contacts the states' PATH coordinators to follow up on all unresolved issues identified by the grants specialist and program review panel. The Director contacted the five states included in our review to follow up on their fiscal year 1993 applications. For example, the Director asked Florida officials to report on the impact of Hurricane Andrew on available PATH services and to define items included in the state's administrative costs. Florida officials reported that the hurricane disrupted PATH activities in three counties, including the cities of Miami, Key West, and Fort Lauderdale. State officials also revised the budget estimates to comply with the 1990 McKinney Amendments' administrative cost limit. The Director also asked New York officials to clarify the state's planned use of PATH funds to support holding and housing beds. The New York officials explained that local providers would use PATH funds to hold a resident's bed in community housing programs in the event a resident is hospitalized for more than 15 days. New York officials further explained that supportive housing is a rental assistance program and that funds would be used for eligible services such as minor repairs and security deposits. The Director also asked California, Illinois, and Texas officials, respectively, to submit intended use plans, identify the number of persons served, and define clinical terms. The PATH program has not denied states their allotments; however, PATH has delayed allotments until the states resolved open application issues. ANNUAL STATE REPORTING -------------------------------------------------------- Letter :3.1.2 The 1990 McKinney Amendments require PATH grantees (the states and territories) to annually report the prior fiscal year's program activities and expenditures by January 31. The PATH Director, as well as other CMHS officials, wanted to use the year-end annual reports to compile statistics, to evaluate program effectiveness such as the number of homeless individuals reached, and to ensure that states and territories provided the services listed in their grant applications. However, HHS officials acknowledge that the early data collection format for the report was difficult for states to use and resulted in inaccurate or inconsistent information across the states, in some cases. HHS allowed states to defer reporting of fiscal year 1991 activities until January 1993.\7 PATH officials also modified fiscal year 1993's reporting format to make the instrument easier for states to use and made more comprehensive revisions for fiscal year 1994 data. For example, the fiscal year 1994 annual report requires the states to report on the number of dually diagnosed persons served and demographics information for PATH clients; these statistics were optional information in prior years' reports. In addition to requiring further statistical data, the PATH program is working to develop outcome or person-centered data. Such data would measure the impact of services on the homeless individual's life. In August 1992, the PATH Reporting and Evaluation Group--comprised of 23 representatives of state mental health agencies, local providers, mental health consumers, researchers, members of the National Association of State Mental Health Program Directors, and HHS--developed data collection and analysis principles on the type of person-centered information needed. A partial list of desirable outcome data includes information on client satisfaction and the impact of prevention efforts such as onetime rental payments or clinical crisis intervention. The group also recognized that the data should be relatively inexpensive to collect and should be useful for monitoring programs. -------------------- \7 HHS offered the states the option of postponing fiscal year 1991 reports until January 31, 1993--the due date for the fiscal year 1992 reports--because the Department did not distribute the fiscal year 1991 grants until the last quarter of fiscal year 1991. ON-SITE MONITORING -------------------------------------------------------- Letter :3.1.3 HHS' on-site monitoring protocol includes observing selected local provider activities and meetings between the PATH Director and the state's PATH Coordinator concerning the state's organizational structure for delivering mental health services; techniques the state uses to ensure that local providers deliver services; and the state's working definitions of "homelessness," "serious mental illness," and "co-occurring mental illness and substance abuse disorders." The PATH Director first tested the protocol in Tennessee in August 1993. She reported that on-site monitoring will augment her understanding of the states' and territories' PATH programs. The Director plans to visit six to eight additional states during fiscal year 1994; she is the only full-time PATH employee. The Director will address statutory and regulatory issues she identifies and will refer program implementation matters to a technical assistance contractor.\8 -------------------- \8 Under contract with HHS, the National Association of State Mental Health Program Directors provides PATH-related technical assistance to the states. The technical assistance contractor staffs a hotline to answer the states' programmatic and implementation questions, issues newsletters, conducts six 2-day workshops and training sessions annually, and plans and hosts periodic national meetings bringing all 56 PATH Coordinators together. Issues addressed in the newsletter include how to effectively deliver PATH services to homeless women and children, how to achieve state and local provider accountability, and how to provide client job training. The technical assistance contractor is most often asked to conduct workshops on delivering services to the dually diagnosed and developing and accessing housing for the homeless mentally ill. STATE-LEVEL CONTROLS ARE DESIGNED TO HELP ENSURE PROGRAM INTEGRITY ---------------------------------------------------------- Letter :3.2 State-level program controls that are designed to ensure program integrity include conducting a needs assessment and maintaining oversight of local providers' finances and programs. States are required to identify geographical areas with the greatest need for PATH services before selecting local providers. States also must develop their own methods for monitoring the financial and program performance of local providers. The five states we reviewed identified high-need areas within their states before selecting local providers. Illinois distributed funds to four urban areas based on the percentage of poverty in the urban area, the number of persons in the urban area, and the percentage of overcrowded housing.\9 Florida distributed funds to 7 of its 11 service districts based on the estimated number of homeless persons in each district. New York based the PATH fund distribution on estimates of the number of homeless persons within the state and the statewide distribution of the homeless mentally ill. New York awarded 75 percent of the grant to New York City and equally distributed the balance among Long Island, the Hudson River area (including Westchester County), and central and western New York. Texas chose to fund the state's seven largest urban areas, along with three nonurban areas. California distributed PATH funds to its counties based on a formula that included the number of households with incomes below 125 percent of the federal poverty level and the number of unemployed persons. -------------------- \9 Illinois distributed PATH funds to providers located in Chicago, East St. Louis, Joliet, and Rockford. FINANCIAL AND PROGRAM OVERSIGHT -------------------------------------------------------- Letter :3.2.1 States hold local providers accountable for appropriately delivering the agreed-to services by conducting periodic site visits and requiring providers to report their anticipated outcomes. For example, California, Florida, and Texas PATH Coordinators conduct site visits during the program year to validate local provider adherence to program requirements and to provide technical assistance. These states' providers must also submit expenditure reports documenting how they have used PATH funds. New York delegates oversight responsibilities to a local governmental unit or to the state's mental health regional office. In Illinois, state officials visit local providers biannually. In addition, the state links Chicago-area local providers into a homeless mental health network. An Illinois PATH contractor, Systems Administrative Management Entity (SAM-E), oversees the network's activities. SAM-E visits a network provider weekly to identify problems, monitor and coordinate network services, and train network staff as needed. For example, SAM-E found that one local provider had not fully staffed the program in accordance with its PATH agreement and was not delivering the agreed-to services. When the provider did not correct the problem, the state did not renew its PATH contract. MENTAL HEALTH ASSESSMENTS -------------------------------------------------------- Letter :3.2.2 The PATH program targets homeless individuals and at-risk populations with serious mental illnesses and those with co-occurring serious mental illnesses and substance abuse disorders. To ensure that the program serves the target population, many local providers perform mental health assessments. Typically, providers performing such assessments include nonprofit community-based mental health organizations and county departments of health. We visited two Chicago local providers to observe their assessment processes and determine how their assessments ensured the appropriateness of homeless individuals for receiving PATH services. The Bobby E. Wright Comprehensive Community Mental Health Center, Inc., gets client referrals from three sources: hospitals, community-based agencies, and the public. The type of referral is the primary factor triggering the extent of mental assessment the Wright center will perform on potential clients. Hospital referrals are the most comprehensive and typically include psychiatric and psychological test results and diagnoses. These diagnoses are based on the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM-III-R).\10 Community-based referrals are less comprehensive and have limited psychiatric information about the potential client. Usually the PATH screener reviews the available information on the potential client and can accept the information, request more data from the referring agency, or schedule the potential client for in-house diagnostic tests. Public referrals from the police, relatives, friends, and others are the least comprehensive of the three and usually require Wright staff to conduct a comprehensive mental health assessment on the potential client. The Wright center's comprehensive assessment is a 30-day, three-step process leading to a DSM-III-R diagnosis. The caseworkers initially screen a potential client to determine whether he or she is homeless and whether the client appears to have a mental health disorder. If a client appears to meet the program criteria, he or she is provided with temporary housing. Caseworkers then collect data to develop a psychosocial history that could include historical information on the client's problems, illegal and legal drug use, medical recommendations, a tentative diagnosis, and other pertinent information. A psychiatrist also tests and observes client activities and gives the potential client a clinical diagnosis. At the end of 30 days, the caseworker, psychiatrist, and others review the case, confirm or revise the client's initial diagnosis, and then develop and help implement the client's individual treatment plan. An individual treatment plan is a customized strategy that outlines a client's needs and goals with a view toward helping the client become self-sufficient. Thresholds Bridge Program-Mobile Assessment Unit receives referrals from the same sources as the Wright center. In addition, Thresholds identifies clients through street outreach. Two-person teams, consisting of a qualified examiner who is a licensed clinical social worker and an outreach worker, drive, bike, and walk around metropolitan Chicago to locate and identify potential clients.\11 Once the team identifies homeless individuals, the assessment process begins. The team talks with each homeless individual to assess his or her mental functioning and to obtain historical information on the person's medical and psychological condition, familial structure, and illegal and legal drug use. With this information, the team begins developing a DSM-III-R diagnosis. If a potential client is in the midst of a medical or psychiatric crisis, the team calls for immediate services. When there is no crisis, the assessment process can take days or months depending on the potential client's willingness to receive services. According to the Mobile Assessment Unit's Director, it may take several visits with a homeless individual before the person develops enough trust to accept Thresholds' services. -------------------- \10 Diagnostic and Statistical Manual of Mental Disorders: DSM-III-R, Third Edition, Revised (Washington, D.C., 1987). The manual includes more than 200 mental disorders and diagnostic criteria for each disorder. \11 In Illinois, a licensed clinical social worker holds a license authorizing the independent practice of clinical social work under the auspices of an employer or in private practice. The licensed clinical social worker must apply for licensure with the State Department of Professional Regulations and must have either a master's degree in social work and at least 3,000 hours of supervised clinical professional experience or a doctorate degree in social work and at least 2,000 hours of supervised clinical professional experience subsequent to earning the degree. ---------------------------------------------------------- Letter :3.3 We discussed a draft of this report with HHS' SAMHSA, CMHS, and PATH officials. They generally agreed with the information presented. We have incorporated their comments where appropriate. We are sending copies of this report to other interested congressional committees, the Secretary of Health and Human Services, the PATH Director, and other interested parties. We also will make copies available to others on request. Please call me on (202) 512-7119 if you or your staff have any questions concerning this report. Major contributors to this report are listed in appendix IV. Mark V. Nadel Associate Director National and Public Health Issues SCOPE AND METHODOLOGY =========================================================== Appendix I To gather PATH program information, we interviewed HHS' Substance Abuse and Mental Health Services Administration and Center for Mental Health Service officials responsible for policy and program oversight, and the PATH program Director. We also interviewed officials from the National Association of State Mental Health Program Directors--the PATH program's technical assistance contractor, Illinois' PATH Coordinator and two Chicago-area providers: the Bobby E. Wright Comprehensive Community Mental Health Center, Inc., and the Thresholds Bridge Program-Mobile Assessment Unit. We reviewed HHS' program application, monitoring, and reporting guidance. We also reviewed fiscal year 1991-93 grant applications from California, Florida, Illinois, New York, and Texas and follow-up on the states' applications. Further, we reviewed the five states' fiscal year 1991 and 1992 annual reports. These five states received over 34 percent of fiscal years 1991-93 PATH allotments and accounted for 62, or 16 percent, of the nation's fiscal year 1992 local PATH providers. We did not test the adequacy of the five states' financial controls, nor are the results of our work projectable to other states. In addition, we contacted state PATH officials in Florida, Nevada, and New Hampshire to obtain information on PATH local providers and clients in fiscal years 1991 and 1992 missing from HHS' data. Our review concerned use of federal funds and program monitoring only; we did not assess the effectiveness of the programs. We performed our work from May to November 1993, except where noted, in accordance with generally accepted government auditing standards. FISCAL YEARS 1992 AND 1993 STATE AND TERRITORY ALLOTMENTS FOR PATH PROGRAM ========================================================== Appendix II State 1992 1993 ------------------------------------ ---------- ---------- Alabama $300,000 $300,000 Alaska 300,000 300,000 American Samoa 50,000 50,000 Arizona 396,000 386,000 Arkansas 300,000 300,000 California 3,800,000 3,705,000 Colorado 355,000 346,000 Connecticut 366,000 357,000 Delaware 300,000 300,000 District of Columbia 300,000 300,000 Florida 1,519,000 1,481,000 Georgia 487,000 474,000 Guam 50,000 50,000 Hawaii 300,000 300,000 Idaho 300,000 300,000 Illinois 1,265,000 1,233,000 Indiana 402,000 392,000 Iowa 300,000 300,000 Kansas 300,000 300,000 Kentucky 300,000 300,000 Louisiana 332,000 324,000 Maine 300,000 300,000 Maryland 534,000 521,000 Massachusetts 706,000 688,000 Michigan 867,000 846,000 Minnesota 354,000 345,000 Mississippi 300,000 300,000 Missouri 415,000 405,000 Montana 300,000 300,000 Nebraska 300,000 300,000 Nevada 300,000 300,000 New Hampshire 300,000 300,000 New Jersey 989,000 964,000 New Mexico 300,000 300,000 New York 2,106,000 2,054,000 North Carolina 375,000 366,000 North Dakota 300,000 300,000 N. Mariana Islands 50,000 50,000 Ohio 993,000 968,000 Oklahoma 300,000 300,000 Oregon 300,000 300,000 Pennsylvania 1,075,000 1,049,000 Puerto Rico 317,000 309,000 Rhode Island 300,000 300,000 South Carolina 300,000 300,000 South Dakota 300,000 300,000 Tennessee 331,000 323,000 Texas 1,697,000 1,654,000 Utah 300,000 300,000 Vermont 300,000 300,000 Virgin Islands 50,000 50,000 Virginia 571,000 557,000 Washington 480,000 468,000 West Virginia 300,000 300,000 Wisconsin 368,000 359,000 Wyoming 300,000 300,000 ============================================================ Total $29,400,00 $28,874,00 0 0 ------------------------------------------------------------ Source: HHS. FISCAL YEAR 1992 NUMBER OF PATH CLIENTS SERVED, BY STATE/TERRITORY ========================================================= Appendix III Number of PATH State clients\a -------------------------------------------- -------------- Alabama 1,091 Alaska 79 American Samoa 200 Arizona 493 Arkansas 915 California 47,723 Colorado 776 Connecticut 667 Delaware 199 District of Columbia 105 Florida 2,157 Georgia 1,027 Guam 37 Hawaii 518 Idaho 357 Illinois 1,442 Indiana 1,171 Iowa 697 Kansas 635 Kentucky 653 Louisiana 211 Maine 845 Maryland 452 Massachusetts 1,302 Michigan 1,527 Minnesota 803 Mississippi 166 Missouri 2,417 Montana 1,338 Nebraska 260 Nevada 1,003 New Hampshire 1,976 New Jersey 2,630 New Mexico 231 New York 2,570 North Carolina 594 North Dakota 642 N. Mariana Islands 45 Ohio 2,407 Oklahoma 584 Oregon 194 Pennsylvania 2,068 Puerto Rico 457 Rhode Island 603 South Carolina 791 South Dakota 355 Tennessee 635 Texas 3,362 Utah 486 Vermont 893 Virgin Islands 26 Virginia 1,978 Washington 762 West Virginia 762 Wisconsin 1,833 Wyoming 213 ============================================================ Total 98,363 ------------------------------------------------------------ \a The 1990 McKinney Amendments do not require the states to provide clients with all eligible PATH services nor do they require states to emphasize all eligible services equally. Source: HHS. MAJOR CONTRIBUTORS TO THIS REPORT ========================================================== Appendix IV HEALTH, EDUCATION, AND HUMAN SERVICES DIVISION, WASHINGTON, D.C. Sarah F. Jaggar, Director, Health Financing and Policy Issues, (202) 512-7119 Bruce D. Layton, Assistant Director CHICAGO REGIONAL OFFICE Enchelle D. Bolden, Evaluator-in-Charge Shaunessye D. Curry, Evaluator Leslie F. Fautsch, Intern RELATED GAO PRODUCTS Homelessness: McKinney Act Programs and Funding Through Fiscal Year 1991 (GAO/RCED-93-39, Dec. 21, 1992). Homelessness: Single Room Occupancy Program Achieves Goals, but HUD Can Increase Impact (GAO/RCED-92-215, Aug. 27, 1992). 1990 Census: Limitations in Methods and Procedures to Include the Homeless (GAO/GGD-92-1, Dec. 30, 1991). Homelessness: Transitional Housing Shows Initial Success but Long-Term Effects Unknown (GAO/RCED-91-200, Sept. 9, 1991).