HHRC: Identifying and Addressing Behavioral Health Needs in Encampments
– Hi, everyone, and welcome
to our webinar today. My name is Jen Elder. I’m the Director of the Homeless & Housing Resource Center. And we are excited to
have a great panel today to talk with you about
identifying and addressing behavioral health needs in encampments. We recognize that this topic is really at the top of a lot of communities’ minds right now in how to approach encampments
in a trauma-informed way, connect people with
services and with housing. So I’m excited. We have a great panel from
Circle the City in Arizona and from the USC Street
Medicine team in California. But before we get started, I’ll start with a quick disclaimer. The Homeless and Housing Resource Center is funded by the Substance Abuse and Mental Health Services Administration, but the views and opinions expressed today don’t necessarily reflect
those of SAMHSA or HHS. Next slide. A couple of quick
housekeeping before we begin. As with all of our events, we are grateful to be joined by American Sign Language interpreters during today’s webinar. So we thank Pamela and
Dave for their time. We also have live transcription
from a human captioner, so we thank Karen for her time today too. If you have any technical difficulties, please reach out to us or
drop a question in the Q&A, and we will respond to you. Next slide. This is also the very first HHRC webinar where we are offering live
Spanish interpretation. We have instructions here on the slide, and we will get those to you
in the chat in Spanish as well. With that, we do have the slides
available today in Spanish, and those are available on our website, and Alicia’s put the link in the chat. Next slide. So the final few notes from me. We are joined by a large group today, so all participant lines will be muted, and we won’t have the
chat feature available. But, that said, we really
wanna hear your questions. We know that you have a lot
of questions on your mind about this topic, so please drop those to
us using the Q&A feature. We’ll get to as many as we
can during today’s session. We received, gosh, thousands of questions
during registration. We appreciate that. The panel has seen them, reviewed them, and is planning to address those during the panel discussion today. As I mentioned, the slides are available on the HHRC website in
English and in Spanish. We’ll have the recording
available tomorrow. And at the end of the webinar, there’ll be a link to a short evaluation. We have that available
in English and Spanish. And you’ll be redirected to a
certificate of participation. So with that, I think I gave a lot of
housekeeping instructions, but if you have any questions, reach out to us during the webinar. But, with that, I’m happy to
pass it over to Katie League and also express our appreciation to the National Healthcare
for the Homeless Council for helping us facilitate
and prepare this webinar. Katie? – Thank you so much, Jen. We are delighted to be with you all today and to have a wonderful conversation. But I would like to start with our land and labor acknowledgement. Our conversation today includes all of us who are located across many communities. Most of our communities reside
on unceded ancestral lands or acquired by unhonored treaties. We acknowledge the people of
these lands, past and present, and honor with gratitude the
land itself and its people. We also honor the brilliance and humanity of all immigrant labor, including voluntary, involuntary, trafficked, forced,
and undocumented people whose labor remains hidden in the shadows but still contributes to the wellbeing of our collective community. By recognizing the land that
was taken from First Americans and the forced labor that was provided by enslaved Africans and
Black and brown people, we strive to take steps towards creating a more equitable
and just world for us all. I will drop a link to Native Land, the source of this where
I pulled this from, and then also encourage you to take time to learn about the land where you live, work, spend your lives. As Jen mentioned, we have a really wonderful and
filled 90 minutes together. My colleague from the council, Kate Gleason-Bachman and I, are gonna start with a
little bit of an overview of the behavioral health needs of people living in encampments and cover some principles of engagement and how encampment sweeps affect health. Then you’re gonna hear from
two incredible programs about the work that they are
doing within their communities. So Circle the City in Phoenix, Arizona and the USC Street Medicine team that is in L.A. and L.A. County. And then we’ll have an opportunity to, after they present on their programs, we’re gonna have an opportunity to present some of those incredible questions that you all submitted to these panelists to answer from their expertise. And we will do our best to get to as many as possible
during our time together. So as I said, we’re gonna start with a little bit of level setting to talk about the behavioral health needs of people experiencing homelessness. So we know that 21% of people
experiencing homelessness have reported having a
serious mental illness, and it’s really important that
we focus on the have reported because anytime we see these numbers it should be assumed that
they are an undercount. That is both because this is a topic and something that people are
not necessarily comfortable and forthright with sharing, but also that we know people
experiencing homelessness live in the shadows of communities and the number of people
experiencing homelessness is underreported. And so the conditions and
health concerns that they have are also underreported. So 16% of people experiencing homelessness also report having a
substance use disorder. We also know that, as of last year, 39% of all people experiencing homelessness in
the U.S. were unsheltered. So when we think of the
categories of homelessness, we know that nearly 40% of all people are living in an unsheltered environment. And then when you look
just at individuals, so not taking into consideration families, that percentage jumps to 50%. And a lack of stable housing and challenges meeting the basic needs make addressing behavioral health needs that much more difficult for people experiencing homelessness. The relationship between
behavioral health conditions and homelessness is complex. It is also bidirectional. And what I mean by that is
behavioral health conditions can contribute to a
person becoming homeless. So, for example, someone with
a behavioral health condition may struggle to work a full-time job due to the symptoms that
they’re experiencing and may no longer be able to afford rent and be able to live independently and support the financial
burden of housing, and become homeless. Or a person who may begin experiencing their behavioral health symptoms as a result of their homelessness. So this could be a new diagnosis of PTSD related to trauma, anxiety as a result of being unhoused and being uncertain how they’re going to
meet their basic needs. And this person may begin using substances to try and cope with
some of these stresses. And, finally, preexisting
symptoms can become worse as a result of being in a homeless state. And so that bidirectionality means there is no one beginning and end. One is not the cause of
the other exclusively. And we know for a fact that not all people living
with a mental health condition or behavioral health
condition are homeless but that those conditions
are often made worse by the instability in
the lives of somebody who has to live their private
lives in public spaces. What we know for supporting people with behavioral health needs and supporting people
experiencing homelessness, there are core factors that are the same, and engagement moves
at the speed of trust. So we must start with a
nonjudgmental engagement approach. And what this can include
is consistent access to the supports that they need and to the providers
that they want to see. So we must meet them where they are and that we must be consistent and show up to earn that trust which
will open the doors for opportunities for engagement. We also know that consistent
access to medication is far more difficult when
somebody is living unsheltered. With that, it is
essential that we approach working with somebody
experiencing homelessness who has behavioral health needs with a harm reduction approach. And what we mean by that, because it can be very all encompassing, is that we really do start where they are, with what their goals are and what they would like to address. And we start by trying
to work on the things that they are finding
troublesome in their lives, the things that they
are looking to change, that are creating difficulty for them. That is what is harming them, and so that is what we
define as the harms. Not what we might view as the harms, but rather what they
identify as being harmful to their lives and to
reaching their goals. And we start in those spaces to be able to really move with them towards achieving those goals, which will help with the trust building. And with this we must be prepared, not just to have a
trauma-informed approach, but a healing-centered one. And what I mean by that. It is not just enough to assume that somebody may have experienced trauma, but rather that we want to be instruments of not perpetuating that trauma. And so that must mean
that we are dependable, that we underpromise and overdeliver in the care and the expectations
that we set for someone, that we recognize that
we are not just there to collect information for
our own interest or curiosity, but rather it must be centered directly around the individual’s goals. I’m gonna turn it over
to my colleague Kate now. – Hi, thanks, Katie. Hi, everyone, thanks for being here. So I’m gonna talk just a little bit more about how encampments
and living unsheltered can or may impact behavioral health. And I first just wanna
start by saying, you know, we know, as Katie just outlined, that the experience of homelessness, regardless of the setting, has an impact on people’s
behavioral health, both in terms of their symptoms and in terms of their ability to get care. So I just wanna first recognize that and then also recognize that the ideal and that what we really want for people is safe and stable housing. So we’re talking here about encampments. I am gonna talk about some kind of protective
and then harmful factors around living on shelters in encampments, but wanna first acknowledge
housing is, obviously, the safest and best
place for people to be. So, as I mentioned, there can
be both positive or protective and negative impacts to
living in encampments. So in terms of what can be positive, a lot of times there is a sense
of community and belonging. People have peers who they know, who they have relationships with, and who they know they can rely on, and that can have a really positive impact on their behavioral health. People living in encampments
also often have access to outreach and support services that are coming into the
encampment who know where they are, that they’re there and that
they are needing services. And so that’s a way for them
to access needed resources. Another positive impact can be
that proximity to resources, both in terms of people coming in but also in terms of
where they are staying. And so sometimes people stay in a location where they’re close to the physical resources that they need, places where they get food, places where they use the bathroom, places where they get medical care, behavioral health resources. So those are all positives. In terms of the negative, we know people can have a very hard time safeguarding their belongings. That can have a big impact on people’s wellbeing
and behavioral health. They can be very high traffic, lots of coming and going,
high-noise locations, which can really impact people. There can be very limited
or no access to water, bathroom facilities, ability to shower, to do personal care. The exposure to the elements
is quite a risk for people, both physically and in terms of their mental and behavioral health. And then there is a pressure
to meet basic needs. Because of these elements
of being unsheltered, people often have to go to great lengths and can risk their personal safety around trying to get
their basic needs met. Next slide please. So as I had mentioned, we often see this kind of mixed impact on behavioral health
and people’s wellbeing. And I also just wanna point out, you know, behavioral health is
quite linked, as we know, to people’s physical health and to their physical circumstances. And so these things all contribute to someone’s overall
behavioral health picture. So, as we said, you know, not all attributes of an encampment necessarily have a clear
positive or negative impact. So it’s important to
explore with each person how they’re impacted as well as how best to keep them safe and to reduce any
potential harms for them. So there are two things here
that we’re gonna talk about that have a mixed impact, although it’s not
exclusive to these things. So some of what is protective about living in an encampment setting are a direct result of
the impact and difficulty of accessing high-barrier shelter spaces, abstinence-only shelter spaces, or places with policies that make it hard for people to enter and stay in shelter. And so sometimes people have sought out an unsheltered situation because they have had great difficulty getting into a sheltered
space or staying there. In terms of personal safety, encampments can provide some
improved personal safety because of the peer
relationships and community that we talked about. So because people are present, someone is there to
respond to an overdose, someone may be there to help
someone who’s in trouble, who’s having some type
of a mental health crisis or even a physical emergency. But at the same time, we know that being unsheltered also exposes people to the
potential for violence, maybe just by the nature
of living outdoors, not having a place they can really close
a door to and be safe. And so we know that this
is a two-sided situation. Similarly, access to substances can have kind of a mixed impact on people. So we know access to substances can sometimes be an issue for folks, especially if they have
a fear of withdrawal. And so for people who are
wanting to prevent withdrawal, being in an unsheltered
space gives them more access to be able to prevent
those withdrawal symptoms. It can be very hard for
someone who’s actively using to stay in a abstinence-only
or sober shelter, especially if there are not
support services for them, as the reaction to withdrawal can be quite physical sometimes. So having that access can
be an advantage to people. It’s a reason people
choose to be unsheltered. However, we also know that having access to
substances and using outside can increase someone’s risk of overdose. For people who have a goal to decrease or stop their substance use, it can be very challenging
when they’re in a place where they have a lot
of access to substances. And so, again, this is something
that can be quite mixed. Next slide please. I wanna say a little bit about the recent Supreme
Court decision, “Grants Pass.” So in June, 2024, the
United States Supreme Court ruled that the practice
of fining and ticketing people who sleep in public does not violate the Constitution’s ban on cruel and unusual punishment. So while many communities had already been conducting
encampment sweeps, a lot of us may be coming from communities where this has been happening, the ruling did provide more
backing to the practice of ticketing and arresting
people for being unsheltered. And so it is a little
different to, you know, move people along which can be challenging of its own right. But to have ticketing or arrests
happening at the same time can be even more challenging and have a lot of implications for people moving down the road as they’re trying to get into housing. It can have financial implications. Under this ruling, sweeps and arrests can occur
without offering any services or making any referrals
to shelter or to housing. As we know in a lot of cases, there is an attempt to provide housing when an encampment sweep is happening or referrals to shelter. This does not have to
happen under this ruling. And I do just wanna
remind folks, you know, this ruling does allow
for these practices. It does not mandate them. And so communities can
still make their own choices around how they support people who are unsheltered in their community. Next slide please. I also just wanna talk more broadly about the impact of
encampment sweeps on health. And this information
is based on a statement that came out from the American
Public Health Association this year, this past year, about the harm that can happen to people who are experiencing encampment sweeps, who are being displaced from encampments. So there can be impacts to
personal safety and trust in the supports that
are available to them. So as people are moved along,
they do lose their community, they lose folks who were
looking out for them. They may be in a place that
they’re not familiar with. They don’t have folks
who they can turn to. And so this can really impact safety. People often lose their belongings. Their belongings are frequently
thrown away in sweeps. And so this includes medications, including life-saving medications. It may include safer use
supplies like syringes or other things that people are using to try to decrease their
risk of infectious disease. So it can really be challenging for folks to lose those personal items. People may lose contact and trust with needed medical care and supports. As we said, a lot of times in encampments there are outreach services
that are coming in. When people are being
swept and moved constantly, it’s very hard for those
healthcare providers or outreach workers, community
health workers, folks to reach the people they
have been interfacing with. They may not know where they went to. And so it’s really difficult
to have continuity of care. People’s ability to continue moving towards permanent housing can be impacted. This may be because of loss of documents. So people often lose their
birth certificates, their IDs, any identification is lost when their belongings are thrown away. And so that can really impact someone’s ability to get into housing. Similarly, if outreach
teams cannot find people, they often then cannot
continue a housing process that may be ongoing. I also wanna acknowledge that the impact of encampment
sweeps and displacements does disproportionately impact folks who have been historically marginalized. And we know this is true for experiences of
homelessness in general, and we certainly see this
happening in encampment sweeps. So with that, I am gonna turn it over to Joseph Becerra from USC Street Medicine to talk a little bit about
the work that they’re doing. – Hey, guys, how’s everybody going? My camera on? Can you see me? – You look great, Joseph.
– Okay, I couldn’t tell. How you guys doing? My name is Joseph. I’m the Supervising Community
Health Worker here at USC. Go ahead and go to the next one. So this is kind of like
who I am, what I’ve done, and kind of like all the boring stuff. Go ahead and go to the next
one, go to the next one. All right, so USC Street Medicine. We bring medical care
designed to meet the needs of people experiencing
unsheltered homelessness to them in their environment. Of course we go 100% backpack, we go straight to the patients on the streets, in parks, under bridges. Wherever they are, no
matter where they’re at, we’ll go to them. This includes not just
outreach to connect patients to brick-and-mortar clinics, but real medicine right
there on the street. So of course, again, we
do 100% backpack medicine. So we go to the patients because we know that a lot of times the patients can’t come to us. So the primary care. Health screens designed to
meet the needs of the streets. We see what’s going on with them, how long they’ve been on the streets, what their main needs are. And we do work with acute
and chronic diseases, including, we do birth control, we do STD treatment and screenings, we do hepatitis C
treatment and screenings. So we also give meds for
the Hep C when needed. We do a lot of substance abuse work on the street, of course, because we know a lot of people are using. Includes long last… Sorry, long-acting injectables,
anti-psychotics, the LAIs, and other medications that help patients with bothersome symptoms
like hallucinations. We have so many, and like everybody else, there’s just so much
going on in the streets that we have seen that a lot of these long-lasting
injectables are amazing, as some of you guys
might also be doing it. But it really works and it
really helps tremendously. We do a lot of wound care. That’s one of the primary
things that we see a lot is a lot of the wounds from
either injecting the xylazine or just picking and just
living out in the streets, not taking showers, not being
able to, you know, self-care. And we do a point-of-care
ultrasound on the street also, which is really amazing because we can let them know if anything’s going on
directly right then and there. And, of course, if not,
then, as I said earlier, we do try to get them to like get x-rays and other types of imaging that they need. So we will direct them either to the hospital or the clinics. We’ve got specialty services like HIV care, behavioral health, we have a street psychiatrist, we have clinical social
workers that come down. We do gender-affirming care, which is also we give
the hormone injections. We have social work that’s with us also. So they do a lot of the
case management work with the housing and
just getting their IDs and helping them get like their
Medi-Cal or their benefits. And just a bunch of other stuff that we do right there with them. And enhanced care management. We do a lot of enhanced care management going alongside with them, trying to help them get further and help them get what’s needed for them. Go ahead and go to the next one. So who’s on the team? All these ugly folks there, except for me right there, of course, but all the other ones. We got providers, which are MDs. We have many PAs that are
mostly the providers on there. We have NPs, psychiatrists, and LCSWs. They also accompany with RNs. Every team is a CHW, which it’s CHW-led on the streets. So teams mostly. We have all these, but not
everybody goes out, right? We have the ECM component, we have caseworkers and admin staff. But with our teams,
it’s built to the CHWs, a provider, and then the RN. And then we have just
different specialties, as you see with the psychiatrists, LCSWs, and the caseworkers. Not all them are built on a team. We have separate teams
for them on separate days. So it’s mostly either a CHW, a provider and an RN, or a CHW… I’m sorry, a CHW and RN
or a CHW and a provider. And then you… So we’ll have two areas, and I’ll explain the areas, how we do it. And they’re led by the CHWs, though. Go ahead go to the next one. So this is how we decide where we go. Of course, there’s a
lot of outreach, right? We do a lot of outreach. So these colors that you
see are different areas. The green one is the east side, the blue one is our CD 1 area, the purple is our Hollywood team, the yellow is our Mid-City, and the one down below,
the pinkish kind of one, is our South L.A. team. So we’re geographical. And we’re only in the city of Los Angeles. We were in L.A. County,
but L.A. County is so huge. So as we got our new contracts, we ended up just doing
the city of Los Angeles. Because we’re geographical, the way we work is we do
outreach in these areas that you see, the colored areas. But we do a lot of referrals too. So we got like, of course, you know, when you see a patient, patients are, “You think I’m bad, “you should see my partner.” So we get a lot of
referrals through patients. Most of our referrals
come through patients. The city, because we work really close with the city, Mayor Bass and her team, we work really close with them. We do a lot of the Inside Safe here, the Inside Safe sweeps. And we do a lot of sweeps with them. We help get their patients medical care, and when they’re going to either shelters, hotels, apartments, wherever they’re going, we follow them. We’re one of the only teams who continue to follow our
patients from the street to no matter where they go. And we’ll follow them,
we’ll keep following them. We have patients that we have followed for, oh wow, maybe six years, six to five years, four years. We continue to follow them until
they don’t need us no more. Meaning, you know, we’ve got them situated where they’re okay to go to the clinics or hospitals by themselves, or they just say, “Hey,
let me do this on my own.” And we’re like, “Great, awesome.” We get referrals from, you know, just community partners, from hospitals, the community itself. We’ll get phone calls, emails, saying, “Hey, we have this person “on this street or that street.” And, you know, we’ll go check it out and see what’s going on there. And external organizations,
you know, in-house also. But, yeah, this is pretty much how we decide where we’re going. So each morning we, you
know, gather in a room, and we go over just different
things of what’s going on for the day or the week or the month. And then we break up into our teams. And if anybody has any referrals, we go through the referrals, and we try to see them
as soon as possible. Go ahead to the next slide please. Role of the community health worker. So these are the really ugly guys there. So the role of the CHW,
community health worker, you know, is we’re out there making sure our teams can do their job. So you hear that word a lot,
community health worker. In street medicine, a
community health worker is so much different than
a community health worker in the clinic and the hospital. Just different areas, right? Community health workers
and street medicine, what we do is we do a lot of, situational awareness I
guess you can call it. So scene safety. We make sure that our providers, our nurses, our psychs, our
LCSWs, whoever’s on the street, we just make sure they’re,
I don’t wanna say safe, but we make sure they can do their jobs without any problems going on. So we’re always helping them. And then we’re, you know,
just monitoring the area, making sure people are okay. Usually, you can see the truck here, what the CHW will do on our team is we’re the first person off the vehicle. We go to the encampment
itself, the community, and we speak to who we’re seeing and make sure everything’s okay, that we’re needed that day or, you know, nothing’s going on that day. But a lot of times, if anything is, the community itself will tell us, “Hey, today’s not a good day.” Or, “You know, can you come back?” Or whatever it may be. So, you know, we’re the first people that engage with the patients, first people who may
build the relationships with the patients during the outreach and everything else that we’re doing. And then just to make sure, again, that our teams are just able to be there and do their work safely. So we do a lot of harm reduction. We give out a lot of pipes, we give out a lot of needles, and all the essentials that go with both. And not only do we give them out, one thing I’m always telling my team is to always educate the patients. You can hand stuff out, but, you know, just because people are doing drugs don’t mean that they know how to do drugs properly or safely. So we’re just making sure that they’re out there not only handing out the harm reduction stuff, but it’s a big essential to make sure that people are educated
on harm reduction. And that’s even people who are using. Of course, the outreach,
like we were talking about, just outreaching the communities and making sure everybody’s okay. We keep engaging either when we come in. We come in either with like, you know, water, some type of… I usually have these bags that a buddy of ours puts together. I mean, there is so much in those bags. There’s like 40, $50 worth
of food in those bags and other stuff. And, you know, we approach
them, we give those out. So it’s been a pretty good… Engagement-wise, it’s kind of easy to engage with people on the street. Sometimes people don’t think it is. Because our community health workers have a lot of lived experience, that’s one thing that we look for is the lived experience person. Somebody who’s, I guess you could say, been there, done that, right? Somebody who’s able to
outreach and talk to people and let them know that
they’re okay dealing with us. So we just check truck inventory, making sure everything’s on there. And we do a lot of admin duties
too with all the charting because we are an electronical system that we still have to come back. The community health workers
are in charge of scheduling, they’re in charge of
checking in, checking out and just making sure
everything’s, you know, running smoothly on the teams. Go ahead to the next slide please. Again, role of a CHW
is patient engagement. How do you start engagements? Like I was saying, a lot of times to build a patient’s trust is letting them know that
we know the situation and, you know, how it’s going because of the lived experience that most of our community
health workers have, if not all. And then sharing stuff. Sharing stuff like water, sharing stuff, just like, you know, stories, sharing, letting them know that we’re there because
we care about them and that we are consistent on what we say. So one thing I always tell
our team is be consistent. Never make any promises. Never tell ’em you’re gonna do something you’re not gonna do. Because they will always remember that… Sorry. They will always remember
when you make a promise and you break it, right? So that’s one thing that we do is always say never make a promise. Just, again, the strategies that we use are really just being genuine, just showing that you really care. Just letting them know
that you’re gonna be there when you say you’re gonna be there and you’re gonna continue
to just help them. One thing I always say is
I’m never gonna promise, but I’m gonna promise to help
you as much as I can, right? Yeah, just always be engaged and always just be there when
you say you’re gonna be there. Go to the next slide please. Responding to mental health needs. So behavioral health, substance
use, utilizing MDT support. So we do have a lot of… Our providers do provide MDT. And the harm reduction
is a big part of that with also the substance use. So as you can see, or as you guys know, most of you guys are
working in the streets, it’s about just giving them the proper and the things that they need to continue to be safe out there, continue just to be okay. Do what we can for them to be okay and just continue to
show them that we care, that we always will be there for them. Go to the next slide. Kind of breaks this down more. Oh, that’s it. Okay, sorry. We’re gonna go with the
next Circle the City? – [Katie] Yes, thank you so much, Joseph. And there’s a lot of great questions. Keep them coming in the chat. We will get to many. We’re trying to answer
some as well in writing, but we’ll certainly pull some
of them into the conversation. And so next I’m going to turn it over to the team at Circle the City. It’s located in Phoenix, Arizona, and it is Denise Benson, Thomas
Davis, and Rafael Martinez. Thank you all for being here. – Thanks for having us. Joseph, thank you for
getting the ball started. Next slide please. So I wanted to talk about
our Connection to Care team. Circle the City is set
in Phoenix, Arizona, and we have multiple programs. We have brick-and-mortar programs, we have street medicine,
behavioral health, and medical health. We have medical mobile
units that can move around. We have respite programs for patients struggling with homelessness and have a medical issue that
needs to be taken care of. And so we have all those teams, but we were noticing that there
was a lack of a connection, and with the increased sweeps, that our patients were
moving around a lot more. So we were noticing a need
to get some folks out there and scout out Phoenix metropolitan area to figure out where our patients are. So we tried to do that as a team, the street medicine team
with a medical provider and a behavioral health consultant and a medical assistant and the vehicle. And they were out moving around maybe with the medical
mobile unit as well, but it wasn’t a very efficient
way of finding folks. And so what we decided to do is, it wasn’t very effective
in identifying the encampments and engaging patients. So we decided to do a
Connection to Care team where two support staff, patient navigators and a case manager, and we got them a truck,
we got them a map, and we put ’em out there and said, “Drive around and see “where you can locate encampments, “and make connections with them.” And then so now we have this team that’s out there once a week providing realtime information to the mobile street medicine teams by dropping pins to the outreach. So all day long, they’re
one day a week right now, they’re looking and finding
folks that need support. They’re dropping a pin, they’re giving us a brief
description what’s going on, and they’re engaging with that group of what Circle the City has to offer. We’re piloting this program
with Denise and Thomas, and it was very successful, as we’re reaching dozens and
dozens of folks this way. And I’m happy to report
that CTC, Circle the City, has secured funding for two full-time staff and the vehicle to take this program full-time. So I’m gonna turn this over
to Denise and Thomas now so they can tell you
what it’s like out there. Next slide please. Take it away. – From what you see of the picture, it’s not exactly an encampment. Due to the sweeps, most of our clientele
can’t stay in one spot. So what you’ll see is a lot of makeshift, movable-like encampments, large umbrellas, shopping carts, blankets, stuff they can pick up and
move at a very rapid pace. Next slide please. There you go. When it comes to prepping, lots of cold water in hot summers. It’s obviously a commodity
out here in Arizona. There’s a lot of heat strokes. With the substance abuse that increases their
dehydration, it’s a must. We also bring our laptops and phones. That way I can charge, and phones to get them connected to any other resource we
can find that’s available. And of course the right
attitude and mentality when it comes to
approaching our clientele. When it comes to mapping out the area, my partner Denise printed out all the heat respites within Arizona, since those used to be
large gathering spots for the homeless population. Next slide. – Engagement and building trust when approaching encampments. Compassion and humility
is the number one thing. You treat them with respect, and they treat you back the same way. Attitude of equal and acceptance. We straight out tell ’em,
“We’re not the police. “You know, hide your
felonies, put your stuff away. “We’re just here to help you.” Listening and respond to their answers. “Is there anything we can do to help you?” And many are already familiar with the trust of Circle the City. Next slide. – Now, in regards to safety, one no means no go. Basically, it always comes down to having respect for the patient or the potential patient, should
I say, and the individual. The only time I’ll ever say maybe to try to convince ’em otherwise, if they have a wound that needs
to be addressed immediately that they’re in kind of denial about that could either manifest
in something worse. But for most time, majority of time, if they say no, it’s
best to leave them alone. Also just tell ’em that they’re
here for them, can help out. Be aware of body language. Even though they belong to
the homeless population, they’re still people. Just like if you’re in a
grocery store, anywhere else, you’re talking to anybody, you can read someone’s body language. If they don’t wanna be talked to, they don’t wanna be approached, it’s okay to walk away
for your own safety. There is always a vibe wherever you go. The vibe can range from anything. Now, when it comes to like conversations, it’s best to keep it short. But also if the answers are short, like if it goes straight
to “No, yes, I don’t know,” they may not want to even be
be addressed, to be left alone. I’m sure we all fully aware of what this population has
to endure on a daily basis. So sometimes giving the space
they need is always vital. And of course approaching
with humility and respect and avoiding causing defensiveness. I’ll say from my experience and this entire company’s experience, about a good over 90% of
them, of our population are very friendly. They’re still human, and they wanna be talked to
to just like any other person. And approach with
authenticity and genuineness. What I mean by authenticity
is in a sense of, you may be in a different
position of them, and they may be aware of that, but if you approach ’em as if you’re on the same level as them, majority of time, things
will go quite smoothly. And when it comes to
the formal assessment. I think anybody can tell
when they’re being assessed, and it can be highly
disrespectful in a sense. A simple good morning or just talk to them as
a casual conversation can go a long way without
trying to assess them like as if they’re a product. They’re a person, obviously. Next slide. – More than dropping a pin for the team. It’s more than that. It is important to drop that pin so that teams can follow up on folks. Another thing is it’s
also important to listen for opportunities to provide
support, encouragement, and anything that they need you can pretty much get out of the story they’re telling you. Mental health, substance use, social determinants of health resources and follow-up visits to encampments. That’s something we try and
do a lot of is follow-ups to make sure they’re still there, they’re still in the
neighborhood, they’re still safe. Next slide. – Thank you. – Thanks, everybody. So I think we’re gonna
move on to our panel, and we’re gonna hear from the
folks who you’ve heard from with some of your questions. And as Jen said, a lot of questions were
sent in when you registered, and we’ve also seen a bunch in the chat, which has been great. So thank you so much. I know we’ve been trying
to answer some of them, and some of them we’ll
get to in the panel. I wanna start just with
addressing a question that I saw in the very beginning, just asking for a definition
of what an encampment is. So generally speaking, an encampment is any number of folks. Can be very small, one to two people, but it’s people in an unsheltered location who are living somewhere
that’s not an intended place for people to live, who
are staying somewhere. They may have a shelter,
like a tent, a tarp. They also may not. They may just be staying in a doorway. But any of those can meet
the definition of encampment, and those are all folks who have experienced encampment
sweeps or being displaced. So just wanna start there. And then I’m gonna go
into some of the questions that we have gathered
from the registration, and then we will answer
some of your questions that I’ve seen in the chat. There’s definitely some themes, and I think we’ll be capturing a lot of it in the questions that you already sent. So this can be just for
anybody on the panel. I’ll open it up to everybody. Just to talk specifically about what strategies you
suggest or that you are using. And I know you’ve talked about
a few, like Circle the City, with dropping the pins to
identify where people are so the outreach team
can follow up with them. But are there other
strategies you’re using in terms of sweeps? So for people in cities
where sweeps are happening, you know, what do you suggest or how are you working with people in the face of kind of getting
moved on again and again? – Anybody?
(Joseph laughs) So here in Los Angeles we are dealing right now
with a lot of sweeps. We’ve always dealt with
sweeps, right? Everybody. But right here, right now, and a lot of us do believe it’s because the Olympics
are around the corner. I mean, it’s still years away, but it seems like they’re starting to really do a lot of cleaning up here. One thing that we do is we
really talk to our patients. We spend a lot of time with our patients knowing their daily functions and what they do on the daily, where they go, where they go to eat, who their friends are,
who their family is. We really get to know
where they’re at daily. So we get phone numbers of family, phone numbers of friends,
if they have phones. “If you’re not here today,
where will you be tomorrow?” Or, you know, “What does
your morning look like? “You get up, do you have a routine?” Because believe it or not, most people have a routine
regardless of where they live. So we figure out what their routines are, and then, again, like I said, we figure out who they
associate with the most, and we try to just get everybody’s info and everybody’s locations
of where they stay. So, believe it or not, a town
like Los Angeles is huge, but we tend to do find our
patients a lot of the times and know where they’re at. Even when we don’t know where they’re at, we know we’re gonna run into ’em again, and it’s been pretty good with that. So we just tend to really
find out their daily functions and where they’re at all the time, and we tend to find them. – Denise, Thomas,
anything you’d like to add to that conversation? I know one of the things
that is coming across is people are very excited to
hear about your pin system. So maybe if you could share a little bit about what that actually means in terms of if it’s a
particular program you use and how people have access to it. – Depends. Well, our company use iPhones, therefore we can simply
pin it on our phones. So how it works is, when we drive around, meet different encampments
and different people or large gatherings, we’ll pin it. We’ll also talk to the
people within that gathering to understand what’s going on. Similar to what Joseph said earlier, you try to figure out
like what the routines is. Because one of the things
about the sweeps is, we’re pretty sure we all can relate to, is the fact that sometimes you can lose track of patients and people. So understanding where they
go afterwards is vital. But another thing to add onto that is knowing the resource nearby. Just ’cause you don’t know their routine, you can always see like
what shelters are nearby, food banks, even minor
respites or heat respites. ‘Cause recently they started ticketing homeless out here in Arizona, which makes things a lot worse. So just knowing that where
they’ll go like helps out a lot. – There’s an example. We have an example of just this morning, at 8:48 this morning, where Denise and Thomas were out and about before this meeting, and they were at a location
in Northern Phoenix, and they saw an encampment
of 20 people there. And so the pin looks like, let me make sure there’s no… So there’s no identifying information, but it looks like that. A map where they are and description of the 20 people. – [Denise] And the coordinates. – And the coordinates. And then when you saw that this morning, you know, what did you guys
see when you were out there? – [Denise] They were cold. Yeah, it was early so they were cold. They were just starting to
move around, things like that. You know, like you said, everyone’s got a routine
they do in the morning. And they were just heading
off whether to go eat or find somewhere to shower or whatever. – And Phoenix, it’s a desert. So in the morning, it’s
cold, really chilly. Today, it’s gonna be up to 80. So in the heat, it’s gonna be hot, and then the temperature is
gonna drop drastically again, and it’s gonna get cold again. The extreme heat is pretty much over now, but now this is the newest cycle where you go from hot, cold,
to hot, and then cold again. And that’s the new routine right now. – So I kind of think we
do a little bit something, kind of like the same thing you guys do. We always, every patient we see, we get their coordinates, we say what team seen them, and we put it on our OneDrive. So we keep track of all the
coordinates on the OneDrive, which is the same thing
as the ping on the map. You just ping it where it’s at, and then your coordinates will come up. We copy paste it and
put it into our OneDrive so that way we know exactly
where each patient is. – [Denise] So you guys don’t
use a national database? Like we have aa database here, HMIS, that everyone from every
organization puts notes in. And that’s where we find
a lot of the people. That’s how we know someone’s seen them. – We use that too. But a lot of times, you can’t rely on people putting stuff in. That’s the problem. – [Denise] Yeah, that’s true, that’s true. – Because everybody’s part of it. So if you see somebody
and don’t put it in, it’s kind of almost useless, right? – [Denise] Well, yeah,
that’s why we’re try and… We at least update their
current living situation for their housing benefits, you know, so that they’re still homeless
and they still need help. – That’s really helpful. Thank you for explaining this technology. I think it’s really applicable to teams to think about how they
can be communicating with other team members on their own team but also other organizations. Which actually brings
me to my next question specifically about encampment sweeps. If sweeps have to happen, which we know in many
communities they are happening, we could probably debate if they have to, would you want services to be coordinated, and specifically
including law enforcement? One thing we often hear is
that, when a sweep happens, the individuals don’t distinguish between which organizations
are responsible for the sweep and the people who are
there trying to help them. So how in your community do you do this? How do you respond to encampment sweeps? – You know, in Phoenix
there was a coordination between law enforcement and
between the helping agencies. And we used to have a
place called The Zone where there was hundreds
and hundreds of folks that slept around the biggest
adult shelter in Phoenix. And they cleared that
huge zone in sections, you know, where they would say, they would put out notices to everybody saying, “This section is going
to be cleaned out tomorrow, “be cleared out.” And then so with the local
helping agencies ourselves and the police, people were assisted in
leaving that section. They would block it off, saying that, “Anybody stays here, “they will be breaking the law.” And then so they just kind
of kept moving that space wider and wider until it was finally all the way clear, it’s clearly marked
about no camping anymore and that the police were
closely monitoring that to keep it clear. And there are some folks
that we were able to move towards different emergency
shelter and housing, but there’s some folks that just scattered and ended up in the
farther reaches of Phoenix. – [Denise] And at the time there was actually places to take them to. There was open shelter beds, there was money given just to open shelters for those people. There’s not those options right now. They have nowhere to take these people when they run ’em out of the parks. – So those were the
larger cleanup efforts. The smaller, more individualized efforts occur at the local police level where a police officer would
ticket folks for trespassing if they’re hanging around
somewhere too long. And trucks would come by
from the police department and load up their stuff
and throw everything away. And so those were the
smaller, individualized, those weren’t the coordinated
sweeps with agencies. But if that happens
around where somebody is, then we’re available to help them. But it wasn’t organized beforehand the way that the major
sweep in Phoenix was. – So here in Los Angeles, there’s only really one
or, well, everything, all the sweeps go through the city. So here it’s the city, it’s an organization called
LAHSA, which is the housing. It’s the police and the sanitation. So those four here are
all involved together. But one of the good things, so there’s two different
organizations from the city. One is the Inside Safe, and we are actually
developing an Inside Safe team that are just gonna go with Inside Safe. So when the Inside Safe
right now is happening, they always notify us because we kind of like
made it that way now where they really notify us. So the city will notify us and give us a list of who
is in the Inside Safe. The thing with the Inside Safe, there’s a couple different things. They start the area, like a week before, they
start telling people, “Hey, would you like to be housed?” They don’t tell ’em they’re
coming to house them, they just tell them, “Hey, would you like to be housed? “Like how are you feeling
about getting housing? “You know, would you like
us to help you get housing?” They do that for a week. The reason why they don’t tell them, “We’re coming today to house people” because then they would
invite everybody else and it would be too hectic. So the day of the Inside Safe, they start about 6:30 in the morning. All the entities gather together, they talk about what they’re gonna do. They start taping off areas and bringing in the sanitation and the police and everybody else. And then they will start
targeting everybody that they already have
on the list to move. And they’ll bring buses in, and buses will come in and, you know, get the people, the patients, we call ’em patients, sorry, patients, clients, and they will mobilize them on the bus and then move them to where they’re going, hotels, shelters, wherever they’re going. So the good thing about it is we do have a lot of
contact with the sweeps. We’ve actually been able
to do that recently. It hasn’t been all the time, right? And then there’s another part of the city, I forget what they call it. It’s not Inside Safe. There’s one more that basically they don’t
tell nobody, they just do it. And that one kind of sucks because we don’t even know, and nobody knows when they’re coming. They post signs. They’ll post a sign basically and say, “Hey, you guys gotta
be gone by this and this.” So we do get a lot of our patients sending us pictures of signs, or when we go to see
them, we see the signs, and we’re like, “Hey, are they coming?” “Well, they said they
were, but they didn’t.” So that’s the thing. Sometimes they say they are, and then they won’t show up. So everybody gets comfortable, right? They don’t start packing up their stuff. And another thing. With all these moves, you’re only able to take two bags. They give you two trash bags and say, “Here, put your stuff in here,” and that’s all you can take. Or, if you have an RV, if you have a tent,
you have to give it up. So if you have an RV and they’re sending you to a place where you probably can’t
even go in the first place, a lot of people don’t wanna
give up their RVs, right? They say, “Okay, we’ll
give them to somebody.” But a lot of times they
won’t let that happen. It all happens so fast. It’s just like so quick. They’re not expecting it. They’re expected to give up their RVs. I mean, I wouldn’t give up my RV if I stayed in an RV on the street because what if I’m put in a place where, you know, maybe I’m not liked, maybe it’s just not a good area? Maybe there’s just too much
drugs, too much prostitute. Like there’s just so much stuff. One thing we’ve been able to do, though, is tell them, “Hey, when
you guys do these sweeps, “take the whole encampment
and put ’em in one place. “Because you guys gotta understand, “they become friends and family
with these people, right?” One of the problems are, okay, so we put them all in one place, or we don’t put them all in one place, they’re all over the place. Now they have a curfew. Not only do they have a curfew, they can’t have nobody in their rooms. So now their socialization becomes extinct because you have to be at
your room at a certain time, and now you can’t bring
people in your room. So it’s in circles. But, yes, we’ve been able to
at least gather with them. Like I said, we’re building something called the Inside Safe team to just be inside with all the
patients when it’s going on. So we’ll know all the time
when there are sweeps. – Thank you. I’m gonna shift a little
bit just to talk about, we’ve gotten a lot of
questions about people who are having a lot of
behavioral health symptoms. So whether that’s related to
substance use, mental health, a combination of both. Just a lot of questions about how to kind of approach
people and relate to them. So I’m wondering, maybe we can start with
just thinking about like what are the signs that you look for or what kind of tells you
that someone might be having a mental health, a behavioral
health challenge of some sort? And then how do you then kind of approach and support that person? – Well, there’s two. I mean, there’s two tale signs. Either they’re just totally in denial where they say they don’t
have any issues ever. You know, and then I ask them, “Do you consider being homeless a trauma?” “Yeah!” I said, “Okay, so, you
know, there are some things “that go along with that, you know?” Or you can tell by body language. You know, I mean, there’s
some people out there that just can’t control
their body movements at all. And it’s just built-up anger. It’s built up… You know, they’ve been off the meds, they’ve been off of things like that. And we pretty much, I mean, I go out one day, and then I’ll go back out the next day with my mental health provider and my MA. So we’ll try and go back and see the people that
we’ve seen the day before, that I’ve seen the day before. – Yeah, Denise is speaking to our mental health street medicine team, and that’s a team of a
psych nurse practitioner. Denise is the case manager
and a medical coordinator. And then so sometimes she’s out there scouting for her own team to be able to follow up on the next day. – I mean, if you know the patient, it’s probably a little easier
to understand like the decline or something like is really wrong. I mean, that’s pretty
kind of obvious sometimes. But if you don’t know the patient, yeah, then it’s basic, you know, behavior. – Yeah. – What they’re talking about, if they’re seeing or hearing things. I mean, a lot of times you just, you know, have to be
patient and talk to them, treat them like humans, right? Just humanize humans, and just, you know, be
kind in general to people, and you’ll see a lot of the stuff that people are going through at the time and you’ll understand that, “Hey, this person needs a
little bit more than the next.” And that’s like they were saying, that that’s when you bring the people who specialize in this field. ‘Cause it’s gonna be a lot
easier for them than just anyone. – A lot of times we’ll
go into an encampment, and it’s like you said, they’re a family and they’ll tell, “Hey, so and so’s been
not doing so well lately. “They’re off their meds or this or that. “Is there any way you can help ’em out?” You know? – I’ll tell you, those long-lasting
injectables goes a long way. We’ve seen so much on
the street with them, and, I mean, they’re amazing. – Yeah, ’cause if it’s not injectable, then they’re losing their meds every time. You know, somebody’s stealing ’em or the cops are throwing ’em away. You know, they’re expensive. Access is not just gonna hand ’em out, keep handing ’em out. So I think the injectables are the best way once, you know… – Can you all actually talk a little, there were a lot of questions and interest in the long-acting injectables. So a long-acting injectable
for mental health is just a mental health
med that, you know, lasts. Usually it’s for a month. I know there’s a few that
are a little bit longer. But can you all just talk a little bit about what the process is for that? Like who administers them? How do you do it and how do you track, you know, who’s gotten their
medication and who’s due? There were just a lot
of questions in the Q&A about an interest in kind of how to do long-acting injectables
outside of a clinic setting. – For us it’s just, you know, each patient has certain needs, right? So we’re on a electronic tracking system. So that’s basically how we keep track. And it’s either the
provider or the psych doc that would be the ones that are, well, it’s our nurses that are usually giving the injectables. But they’re saying who needs when they’re, you know, talking to them. The problem a lot of times,
though, with long-lastings is a lot of times you have
to be on the pill medication for a week or two before you can even go
into the long-lasting. So that sometimes seems
to be the withdraw, the back fall about it is getting to that part where we can get them on the long-lasting. But for us to track it, it’s not a big deal
because we’re on a system that we’re able to track it. Whoever’s taking charge of that person, on the team, it’s usually the nurse, she’ll, I guess put it down on hers of when each person is
due for their injectables. – We use the electronic medical record to keep track of who is
receiving the injectable. They have a caseload that they follow. And it’s just like nurse practitioner that does the injectables. And it really has been life-changing for some folks that we’ve seen struggling with chronic
homelessness around. And I think, you know,
one of our patients, everybody knew him because he
just walked around this area. And once he started the medication, it was day and night. He was able to follow up
with his housing manager and ended up housing within six months after starting the medication. – Yeah, he’s still housed. We still go to his apartment to see him. And once somebody gets on the injectables, believe it or not, they come seek you out. ‘Cause they don’t ever wanna go back to feeling the way they did before. So they’re not gonna
let you miss the shot, not they’re gonna miss the shot. – Thank you all for that. We’ve had several questions around safety. Certainly for the individuals
that you’re interacting with but also for your teams. So when and how do you decide if a situation is safe for
you to continue to be in? And how do you leave if you
decide that it isn’t safe? Like how do you plan your exit? – Yeah, would you all share the last time you approached something and you’re like, “Whoa, we gotta go”? – Oh, we walked into an encampment, and you could tell they were coming down. Half of ’em were still sleeping. Usually, we’d get there in the mornings, they’re up and they’re moving around. Half of ’em were sleeping, and the other half were
just really agitated. So you could tell it was, you know, Social Security money was gone or whatever income they had was gone and now they we’re all coming down. And I mean, we just don’t turn our back. “All right, here’s some water,” and we just turn around and walk away. You know what I mean? But we don’t ever turn our backs on ’em. And they’re not violent towards you. You could just tell it’s
not the time, you know? – I’m sorry, the question exactly again? How do you know it’s safe? – Yeah, how do you decide, so what’s your spidey sense for determining if something is safe? And then how do you decide to leave if you decide it’s time to go? – So with us, and I’m sure
a lot of people have heard, if they’ve heard either the
Feldmans or myself speak, we use code words. When we see that something’s
getting a little sketchy, you know, we’ll say something like, “Hey, does anybody have
a yellow highlighter?” Because we don’t carry highlighters. That’s a code for the team to know, “Hey, let’s just hurry up and pack it up “and, you know, finish what we’re doing. “That way we can get out
there in a few minutes.” Or one of the big words we’ll use is, “Does anybody have a red pen?” And when you hear red pen, it’s basically drop
everything you’re doing. If you can grab the bags, grab the bags, if not, leave ’em. We’re getting out of there now. And we’ve had a lot of those situations. Not a whole lot, I’m sorry. We’ve had situations
where we call red pen, and everybody gets up and goes. And then what happens is, after that, we get back to the office, we debrief of why and what
we could have did different or if we did everything right. But to know if you’re
going into a encampment and it’s safe, a lot of times… This is just broad, right? Because every encampment is different, and some encampments, most of ’em, you’re only entering because you’re already
dealing with the people. So, you know, a lot of times you’re not entering an encampment
with a bunch of people. You approach the encampment. That’s where the community
health workers will go in first and make sure, like if
it’s a new encampment, who’s there, what’s going on. But if you’re in an encampment
where you know everybody, most of the time the encampment itself would tell you when something’s not safe. Your patients will tell you, “Hey, it’s not a good time to be here.” Or like we had a situation one time where most people probably
would’ve panicked, but the way I know if something’s safe? Somebody pulls up, one of the parents of a kid that’s there, but, you know, the kid’s older, 30, parents there, they’re both homeless. The patient that’s 30
starts arguing with his mom, and they start like yelling and screaming. Everybody’s looking around
like, “What do we do?” A lot of people would’ve been like, “Let’s get out of here,” right? Because it got heavy, and then all these other
people were moving around. The reason why we didn’t leave, we stayed. And the reason why we didn’t leave, because what you do is have to learn how to understand to
read encampments also. Reason why we’re okay,
we had students with us. They were like, “Should
we go, should we go?” And I was like, “No, hold on, let’s wait.” The encampment itself, meaning, the people in the
encampment will let you know. If they’re uncomfortable, then that means something’s uncomfortable. But if they’re just like, “Ah,” keep on going on with their stuff, that means that’s an everyday thing. You know what I mean? That means that it’s not
nothing to really worry about, that you can go ahead and go. Like, “Ah, those guys are always “fighting and yelling and
screaming at each other.” We were doing medical care at the time. You know, my PA looks at me, and I’m just like, “Keep
going, just keep going. “We’ll ease into this and
see what we’re doing.” People were coming,
people were showing up. It was okay. Again, some people would’ve
left, some would’ve stayed. But because we know the
area and we know the people, we chose to stay. So, I mean, it’s
understanding where you’re at and understanding where you’re going. And there was a question
that said, you know, about lived experience. Yes, you gotta have lived experience. A lot of times, I would really suggest to take somebody who understands the streets also because the streets are a whole
different language itself. It’s a whole different movement. It’s a whole different source. So, I mean, it helps if you
know what you’re looking for. And, again, a lot of the
people on the streets, they’ll let you know when
something’s going on. – One of the things that
Thomas and Denise shared when we were putting together and preparing for this presentation is that to not push it
when it’s not there. You know, if you’re approaching
and folks are not engaging and folks are having short answers and folks are not looking at you, then just walk away. You know, that’s a sign
that it’s not open. It’s not welcome. And so why push it? You know, say, “Thank you very much, “and we’ll be around next week. “And hope you guys have a good day.” And you walk away. Don’t push it if it’s not there, you know? But I know we wanna be helpers, I know we wanna save the world, but if it’s not there,
you’re not feeling it, just walk away. Leave before it gets escalated. – Thank you. There have been a few
questions also from people about kind of trust building, and I know you all have touched on that, but are there specific strategies you use for building trust with folks, especially in a setting where
it’s hard to have privacy? So kind of how do you engage with folks when you’re in an encampment setting and, you know, there’s a lot going on? – Well, I mean, we’d walk
up to some encampments, and they start whistling, you know, to let the others know that, you know, somebody’s here that’s not us, you know? And I tell ’em, you know, “Those are your felonies, not mine. “I’m here to, you know,
do you need water?” And right then and there they just start. It’s an icebreaker, you know what I mean? They know that we don’t have any affiliation with the police. We’re there for them. And, I mean, we’ve built enough rapport that you start to see people
in different encampments, you know what I mean? So it’s like we could walk in, 25 people, and there’s three of ’em we already know, and we’re 20 miles away from
where we were last week. So it’s like their own little
world, you know what I mean? – Yeah, they vouch for
you how they know that. – Yeah. – They can say, “These people are okay.” – Yeah. – Also, giving out
pamphlets help out a lot ’cause they will share pamphlets
with other encampments. – Food resources. We’ve walked up with
grapes and stuff like that. You know, we don’t ever
walk up empty-handed. And you’d be surprised what a bag of grapes can
get you in the summer. (Denise laughs) – Oh yeah, ice cold
grapes in in the summer? Oh, they’re so refreshing. – I think consistency, being consistent and saying what you say you’re gonna do, like I said earlier, not making promises. Just showing up when you
say you’re gonna show up. I mean, trust has a lot
to do with how you act, how you present yourself. Again, try not to go into an encampment with too many people at one time. That’s overwhelming a lot of times. My team always wears lanyards. Always identify. You always gotta identify yourself so that way they know
that it’s an organization that’s there to help. They don’t think it’s police, they don’t think it’s, you know, other type of entities that’s there just kind of like trying to scope them out and try to get them out
or trying to harm them. So you just stay really consistent. And, again, just a lot of
respect and a lot of talking and a lot of letting them talk and a lot of just, you know,
showing ’em that you care and that, you know, a lot of empathy. – The attitude, the attitude
that this is their space. This is their home. You know, we are the guest, and that to come in with that kind of humility and respect. – Absolutely. I think those are key to, it’s something we all
want in our interactions, and certainly when we are coming into somebody else’s place of living and really viewing that as their space and being respectful of the fact that you are a guest in that space. It switches the power dynamic to come out into the community, which is really important
in gaining trust, especially when there’s
a healthcare component. Because, far too often, individuals experiencing homelessness, those who have been
marginalized by our society have been mistreated by
healthcare providers. Maybe not us specifically, but that we need to find ways to really distinguish
ourselves from others who have and recognize that we certainly do not deserve assumed trust and also may have to
work harder to gain it. – When we approach an encampment, it’s almost the same thing as
approaching somebody’s home. You wait outside a respectful
distance as you speak to them and begin to build some
trust, some empathy. They’re making the
assessment if we’re safe. And so we need to have
a respectful distance while they make that
determination if we’re safe. – Yeah, it’s a permission too. You gotta ask permission,
you gotta identify yourself, let ’em know why you’re there. But the permission goes far ’cause it is, you’re
entering their communities, you’re entering their houses. – Absolutely. A question for you all about your, I hesitate to use the word typical ’cause I’m sure the answer is there is no such thing as typical, but how do you structure your days in terms of when you decide to go out to the encampment
sites, what times of day? And maybe talk a little bit about why you choose
those particular times. – The weather. For us, it’s the weather. I mean, in the summer, we’re out at 5:00, 6:00 in the morning before it’s getting hot. ‘Cause you’re not gonna find anyone wandering the streets at
2:00 in the afternoon. Not in Phoenix, you know? Just like now we start
later because it’s cooler so they’re hunkered down
a little longer, you know? So, to us, it’s done by the weather. We don’t decide, weather does. – Yeah. – Yeah, us, I mean, we don’t have the big weather issues here. I mean, we do when it, you
know, rains or whatever. But we don’t start on the street till about 9:00 in the morning. And most people are asleep then. We don’t wanna wake them,
we don’t wanna bother them. They’re a little cranky when you wake ’em up in
the morning, you know? We don’t have to deal with… It gets hot but not Arizona hot, right? – Yeah. – It gets cold but not back East cold. California is a little bit
different weather-wise. But we only work in the day. We don’t work in the night, we don’t work early, early in the morning. We start at 8:00 and we’re off at 4:00. We usually don’t go past
two o’clock on the streets unless something is really needed. So, I mean, with us, it’s a little bit more laid back. It’s California, come on, man. (panel laughs) – I think we have time
for just a couple more. One of the other questions
that has come up a lot is, I think you guys have
perhaps spoken to this some, but have you seen a change in your communities since June, which was the “Grants Pass” decision kind of opening the door a little bit more to, you know, being more aggressive with sweeping and displacing people and also with ticketing and arrests? Have you noticed that there’s been a change
since that time in June? – Yeah, we just ran into a
woman just the other day. She was taken to jail. They found something that was on her, but I said, “Were you under arrest?” And she said, “No.” I said, “Well, they had no right. “Did they ask you if they
could search your stuff?” She said, “No.” I said, “That’s not right, you know?” Well, she calls her probation or she calls her her public defender, and, sure enough, they
dropped the charges on her. I told her, “Even though you’re homeless, “you still have rights. “And don’t ever forget that.” But they’ll run ’em off one encampment, and they’ll turn around
and go across the street, and they know that they got 72 hours there before they can punk her up and come back, and they just move back across the street. So it’s almost like a game
they play with ’em, you know? But they have nowhere to go. They have nowhere to offer them to go. So I don’t understand
how they can just keep, you know, trying to run ’em
out of this neighborhood for the property values. You gotta have somewhere to live. – I wouldn’t say there’s been a major
impact since “Grants Pass.” I would just say that there’s a little bit
more sweeps than usual, and that that probably
is affected by then. But, again, we’ve been pretty lucky that we haven’t seen a whole impact. But I think it’s more
here getting ready to, you know, jump up for the Olympics. So they’re gonna start moving them here, there, and everywhere. But again, like she said, they’ll go from one side
of the street to another or around the block and then
just wait and come back. So there hasn’t been, I wouldn’t say really impacted
anything since “Grants Pass.” – Just a lot more
paperwork for them to do. Because, I mean, we have
the homeless courts, and they go in front of a
judge and he dismisses it. So you pretty much just waste
a whole lot of ink and paper because it didn’t get anybody anywhere. It didn’t solve anything. – Regarding community-coordinated experts, I haven’t seen or read anything about that increasing since that passage. – But we have lost two big shelters too. So there’s a lot of people that
were put back on the streets that were in transitional shelters for, some of them a year or two, waiting to get housed and then placed. They lost their funding and closed down. So now they’re all back on the streets. – I do think we’re seeing
more city councils and regions starting to make decisions. Just one announced recently in my hometown paper in Massachusetts, of a rather large city in
Brockton, Massachusetts making the decision, the city council announces that they are banning encampments. And so I do think we
will see some of this. I hope both of your programs remain in areas where that is not the
legislation that is active, but I’m sure many of the
attendees on our call are either seeing these
decisions being made or there is more of an environment where those types of
decisions would be favorable or would be at least considered. And it will certainly impact the way your teams are
perceived by community, by other community programs, maybe by your state, you know, whether it be
your city or your county, your administrators within your region. So I think probably one final
question here for today. What advice would you give to a program that wants to start doing this work? And when I say this work, I mean broadly. So certainly there’s
been specific questions about street medicine, but also touch upon just, I’m sure there are many
programs on the call that are not yet doing outreach, that are not yet necessarily going outside of their brick-and-mortar. So please think of, how would you encourage them
and what advice would you give? – When you go out on the streets, you run into some of the most warmest and, I mean, there’s not a day that we don’t get thanked for what we do, just for giving ’em water
or just for showing up. And it’s a totally different mentality than if somebody comes
into your brick-and-mortar. And, I mean, it’s just right there. It’s a game changer. It really is. So I think everyone should do outreach. Meet ’em where they’re at. – I think you don’t have
to recreate the wheel. If you are interested in doing this and getting it off the ground and figuring out the budget and the cost and how to begin, you don’t have to recreate the wheel. Because, you know, within the National Healthcare
for the Homeless Conference, there’s a lot of resources there. There’s the Street Medicine Institute that also has lots of resources. And you have a lot of members of the National Healthcare
for the Homeless Council that can also be involved
in supporting new programs. You don’t have to recreate the wheel. We’ve learned our lessons. – Main part of it is just funding. I mean, you gotta find the funding, you gotta find the resources, you gotta find who will support the work. I mean, either that or just get
a whole bunch of volunteers. But you know how that goes. – Yeah. – Without the funding, though, that’s the hardest part of the program, and we’ve been pretty
blessed to be 100% funded with a bunch of different ways. So I think the very first step would be finding out who can back you and what it takes, and then who can come on from the backing? Meaning like a provider, a community health worker, a nurse. Those are like three
essentials that you really need in order to start a
street medicine program. So just as long as you have
the funding for your people, I mean, you can do as
much as you really want. – So, to that, I do wanna take a moment. I am dropping two resources
in the chat for everyone. There were quite a few
questions around funding, and this is one in which things do vary greatly state by state. ‘Cause even those things
that are Medicaid, that is administered at the state level. So I think the answer from all
the street medicine programs that I have talked to across the country is the answer is there are
multiple sources for funding. So the term braided funding is often used, just like most health centers. That is the case, that there is not just one funding source. So when possible, street medicine teams, health centers do bill insurance for those individuals who have it. That is certainly not
100% of their clients, but it is an important
opportunity for revenue. There also are opportunities for partnerships within your city, within systems like hospitals
and larger healthcare systems wanting to meet the
needs of their community, being tasked with that. So that is also an option. These are great resources that are here. Thank you to Rafael for
promoting our conference that is happening in May
in Baltimore this year. This is certainly a topic. USC Street Medicine and the
Street Medicine Institute have both published and present often on how they make this possible. And I think one of the things
that has been clearly evident, and I want to take this as an opportunity for thanking Joseph,
Denise, Thomas, and Rafael, is the passion in the
people who do this work and the commitment to finding a way to meet the needs of their community. Really, street medicine and outreach work stemmed from the fact that we know that people cannot access
brick-and-mortar locations for a myriad of reasons and that meeting them where they are in whatever interests
they have at that moment in meeting with us and accessing care and starting from that opportunity, that point of humility to engage and build trust and relationships. Thank you all so much for being here. It’s been a real pleasure. And a special thank you to Joseph, Denise, Thomas,
and Rafael for this afternoon. – Thank you, guys.
– Thank you. – Great, thank you so much. On behalf of HHRC, again, thanks. Just wanted to, if we could, bring up the evaluation
codes while we wrap up. I also wanted to mention, there are a lot of questions
about further training, further training on outreach. Just wanted to flag additional
resources from HHRC. We received about 300
questions during the webinar, so I am sorry we didn’t
get to all of them. But we would be here all day
through the rest of the week. Which I would enjoy
continuing this conversation, but we might need some breaks. So I wanted to let you know we are gonna be preparing additional resources after this webinar. We’re gonna take all of
these questions back with us and look through them and
have them inform our work. So, not to worry, this is the
start of the conversation, not the end of the conversation. And just wanna thank everybody
for spending your time here. So once more, Alicia put the links to the evaluation surveys in the chat. And I think it’s coming up in case you… Yes, if you would prefer the QR code, we’ll keep this open for
just another few minutes. But thank you so much
and have a great day. Take care.
– Thank you, guys. – Thank you, thanks, bye.
– Bye.
“Identifying and Addressing Behavioral Health Needs in Encampments” was hosted by SAMHSA’s Homeless and Housing Resource Center on November 13, 2024.
This webinar discussed core principles and engagement techniques for providers to serve as a bridge to care for mental health, substance use, and medical needs.
Learn more: https://hhrctraining.org/events-webinars/webinar/58102/behavioral-health-encampments
English and Spanish captions available