State of California’s Plans to Integrate a Wide-Range of Homelessness Data Sources Should Include Medical Examiner-Coroner’s Records of Persons Who Died Homeless

Homelessness is much more than the absence of physical housing;
it is a tension-filled, trauma-filled, and treacherous condition
that too often results in injuries and fatalities.

NOTE: Monday, December 21^st, marks the 30th Annual Homeless Persons’ Memorial Day

Legislative Actions Regarding State’s Homeless Data Integration System (HDIS)

The State of California’s plans to integrate data sets on homelessness from a wide-range of sources stemmed from SB-1380 Homeless Coordinating and Financing Council, which was signed into law in 2016. The legislation called for the creation of

“a statewide data system or warehouse that collects local data through Homeless Management Information Systems, with the ultimate goal of matching data on homelessness to programs impacting homeless recipients of state programs, such as Medi-Cal (Chapter 7 (commencing with Section 14000) of Part 3 of Division 9 of the Welfare and Institutions Code) and CalWORKS.”

The legislation noted that

“State programs means any programs a California state agency or department funds, implements, or administers for the purpose of providing housing or housing-based services to people experiencing homelessness or at risk of homelessness, with the exception of federally funded programs with requirements inconsistent with this chapter or programs that fund emergency shelters.”

Next, AB-2872 Persons experiencing homelessness: California Homelessness Data System Act, which was introduced in 2020 but not signed into law, called for the California Department of Housing and Community Development (HCD) to

“Create a state homeless integrated data warehouse, in coordination with state and local partners, including, but not limited to, the Homeless Coordinating and Financing Council established by Section 8257, to compile data from collaborative agencies’ Homeless Management Information Systems.”

The legislation also called for HCD to

“Cooperate and collaborate with each of the following state agencies, as necessary, to draft and carry out a strategy to integrate information from the Department of Corrections and Rehabilitation, the State Department of Education, the State Department of Health Care Services, the State Department of State Hospitals, the State Department of Social Services, and the Department of Veterans Affairs into the data warehouse, to provide longitudinal, cost-based studies.”

            The Evolving Status of HDIS

The Homeless Data Integration System (HDIS) is evolving into a technology solution that will allow the State of California

“to access and compile standardized homelessness data collected (Homeless Management Information System) by individual Continuums of Care (CoCs) in order to make data-driven policy decisions aimed at preventing and ending homelessness in California.”

HDIS will also

“pull the client data required by the U.S. Department of Housing and Urban Development (HUD) from each CoCs Homeless Management Information System (HMIS) into a de-identified database of homeless client service activity. It is envisioned that HDIS will also pull client data from state systems to provide a more holistic picture of state and locally provided services.”

Once implemented, HDIS will

“develop a variety of de-identifiable data tools (e.g., aggregate reports, dashboards, ad hoc analyses) to better understand the demographic characteristics and patterns of homelessness; to inform policy, program, and funding decisions; and to educate the California public about the nature and scope of homelessness. All publicly available data tools will be composed only of de-identified aggregate data and will not contain personal information.” 

Upon implementation, HDIS will also position the State

“to solve a problem that it does not have the data to fully understand” and “align State resources more effectively and efficiently with the needs of local communities,” as noted by an expert in HMIS during a presentation focused on Exploring Development of a California Homeless Data Integration System.

            Recommended Action for Next Steps

Step 1. Integrate Medical Examiner-Coroner’s Records of Persons Who Died While Homeless into HDIS

HDIS will provide an unprecedented level of data to help improve planning, policy, and services regarding homelessness statewide. We will be able to answer questions that we have never been able to answer before, which can include questions about dying on the streets while homeless.

In California, the Coroner Office’s responsibilities include tracking and reporting mortality information that involves determining the manner of death, injury description, causes of death, and residency. Basic demographic data, such as gender, race, and age, are also recorded. This information is often used collectively to provide insights into health threats and disparities, improve outbreak and disaster response efforts, and expose circumstances surrounding sudden, unexpected, and unnatural deaths. This information is also used to compare death trends between cities and counties.

A close look at residency information for the deceased reveals that the Coroner’s Office classifies a significant number of persons as “homeless” or “transient.” A close look at the manner of death, injury description, and causes of death reveals that homelessness is much more than the absence of physical housing; it is a tension-filled, trauma-filled, and treacherous condition that often results in injuries and fatalities.

Past examinations by coroner staff throughout the state have determined that thousands of homeless persons have died under many circumstances, e.g., electrocution, thermal injuries, hypothermia, environmental exposure, drug overdose, and blunt force injuries, including traffic accidents, among others. The coroner records the manner of death, which includes accidents, natural causes, homicide, and suicide. Accidents have involved drug overdose, environmental exposure, structural fires, and traffic and blunt force injuries involving vehicles and trains. Natural causes have included heart disease, hepatitis C, HIV/AIDS, and a wide range of other illnesses and diseases.

Step 2. Create a State Repository for De-identified Records of Persons who Died Homeless and Integrate into HDIS

The State of California should create a repository of all records for persons who died while homeless, according to Coroners’ offices. Integrating the repository data into HDIS would provide an unprecedented opportunity to create new, or improve existing, planning and policies, increase temporary and permanent housing and services for persons languishing on the streets prone to injury and death.

Integrating the repository data could help, among other proactive actions,

• Determine what steps can be taken to prevent the loss of Information from Coroner records can raise awareness of problems such as the high incidence of blunt force trauma by vehicles and trains;
• Signal a larger public health emergency such as infectious diseases including Hepatitis Some California counties have recently declared a local health emergency as a result of an outbreak of Hepatitis C that resulted in some deaths;
• Discover if a week of the month or month of the year has the highest death rates in order to heighten street outreach and other outdoor interventions during a critical period of time; and
• Decide if there are types of locations such as open areas like parks and fields, freeway underpasses, and industrial zones in cities and zip codes where higher concentrations of persons die homeless in order to heighten street outreach and other outdoor interventions within such locations.

However, at this time, tracking and reporting mortality is a complex and decentralized process with various systems used by California Coroner offices. Some uniformity should be required prior to the creation of the repository that includes:

• using a common definition of homelessness to determine homelessness;
• phasing out any paper-based systems and replaced with reputable software; and
• upgrading any outdated electronic systems.

Step 3. Reveal Homelessness as a traumatizing and re-traumatizing experience through HDIS

Homelessness is in itself a traumatic experience. In fact, many persons experiencing homelessness are likely suffering the effects of cumulative traumatic experiences lived in childhood or throughout the life span, which also includes events precipitating or leading up to homelessness. The cumulative effect of traumatic experiences has left many a person languishing and coping with life on the streets and in a constant state of survival.

Homelessness, as a traumatizing and re-traumatizing experience, would be better understood through the integrative actions planned for HDIS. Integrated data sources would likely reveal that homelessness is a traumatizing and re-traumatizing experience for nearly everyone living and languishing on the streets.

For those who died while languishing on the streets, integrating data with Coroner information regarding persons who died homeless through HDIS will likely reveal that for many their deaths culminated in a life full of trauma from the cradle to the grave.