by Suzanne Jarvis

It’s Thursday morning and time for street outreach**. We’re designing a program that creates focused pathways off the street for the homeless based on what matters most to them.  It’s just the beginning.

We meet Martha. Emaciated, she’s sitting cross-legged in the middle of a sidewalk trying to keep her bare legs from scraping the concrete. Doug talks to her. He’s been talking to her on street outreach for six months. It takes that long for many to begin to trust. She tells him she is ready for something different. Her health is deeply compromised. Dr Buck talks to her. She is HIV positive and without medication for months. She needs to be evaluated. Her eyes and entire being appear desperate. They make a plan to bring her to an agency that specializes in working with HIV.

We meet Dave. A veteran, he tells us he has been living on the street for ten years. Chronic homelessness makes him eligible for housing with one exception. He has a sex offense and lives with the label SO. His eyes seem kind. He offers us a bottle of water that was stashed in his tent.

We meet Jenny. Very pregnant, she lives in a tent with her mom, Sarah. She has not had a medical appointment since becoming pregnant.  She uses drugs. Her mom does, too. The team makes her an appointment with a healthcare facility to get examined for health conditions related to substance use. Her eyes avert. It is hard to reach her.

We meet Josephine and Jose. A couple that moves back and forth from Austin to Houston seeking housing. They have all their identification needed to be assessed, so Ken enters their information into the system. They have to wait to be approved. New units have opened up. Ken shows Josephine what they look like through pictures on his phone. Josephine’s eyes light up and a huge smile spreads across her face. She sees what is possible.

We meet Arnold, a veteran with years in the service and an honorable discharge. He was displaced from housing by Hurricane Harvey. He has been working to get off the streets since then. Frustrated by the system that is designed to serve him, his eyes are hurt, his voice is angry. By the end of his rant with us, he shakes our hands respectfully. We discover through another agency he is very close to being housed.

And then there is Harry. He wants to get home to Missouri. He needs a bus pass. He can get one but does not have an ID needed to get on the bus. Staff is not so sure about his story. His eyes appear friendly.

And so it goes. Every person is different. Their needs are unique. Their situations are complex. Life under the bridge.

What happens with Martha, Dave, Jenny, Arnold and Harry over the next six weeks?

Doug brought Martha to the agency that specializes in HIV. She was “too far gone” for them to treat her. He brought her to the hospital and she was instructed to obtain a bedside social worker to approve a four-day stay to stabilize her condition. That night she called our staff. The hospital discharged her at 10 p.m. She was transported to our sobering center to stay safe.

It took another 45 days to get Martha’s blood tested, to get the tests evaluated, to get her medication, to get her stabilized on medication so she could be placed into transitional housing, so she could then wait for a treatment bed to open up to address her crack cocaine issue. It’s torture waiting for treatment when you are ready to not use anymore. She worked with staff daily. Through multiple conversations and heartfelt tears,  Martha was finally willing to let go of her tent and all she owned, trusting staff that she would change her life for good. Martha is staying on track and asked us to please help Jenny.

Dave has been eligible for housing and continuously denied with a SO, so he remains centrally located in his tent and watches the encampment. Although there is an inherent code of silence on the street, he gives information on the people he knows are ready for help. And his insights, too. Street outreach workers consider these members of the community to be advocates for those living on the street. There is resignation in his eyes.

Turns out Jenny never made it to her healthcare appointment before giving birth. We hear from Dave that she delivered a 4-pound, 5-ounce baby boy. Tested with drugs in his system, the hospital keeps the baby. Dave says Jenny plans to retain custody and knows Child Protective Services (CPS) will never allow it. Jenny’s mother, Sarah, finds me on the street. She’s desperate to contact her sister, Jenny’s legal guardian, to see if she can get custody of her new grandchild. She bursts into tears. “I am an addict. I have been fighting this disease for 30 years. In and out of treatment, but never kicked using. It’s horrible. It’s so awful.” And she sobs. And she sobs. And she sobs. Sarah wants her grandson to be safe and loved. She cannot visit him because she does not have identification allowing her into the hospital unit. Sarah nicknamed her grandson TJ. “I am the only one who can call him that. Just me.”

The day Josephine and Jose learned they were approved for housing, Josephine’s smile beamed to the moon and back. I wish I had a picture of the joy on her face. No more than 5 feet tall and 90 pounds, she hugged everyone with her petite arms. The day before their appointment to be housed, Jose gets into an altercation and is stabbed seven times. He survives and continues to recover in the hospital. His slayer remains in the encampment. Josephine is staying with him in the hospital to stay safe. The outreach team keeps tabs on them. If the appointment was one day earlier, they would have been housed and avoided the stabbing. They were so close to getting off the street. So close…

Arnold stayed strong, persisted through the system, and finally got housed. He is able to work. We hope this placement brings a new trajectory to life. Harry meets us and greets us with the street knuckle hand punch. He has not been successful getting his birth certificate from Missouri to get his ID. So no bus pass out of Houston. He implores us to be careful in the encampment telling us, “You can get guns and any drugs you want in there”. He doesn’t appear to use. His eyes are upbeat.

Yes…men dressed in hospital scrubs driving expensive cars show up in the morning to do their daily rounds. It is not medicine they are peddling. They are the drug dealers offering people their morning fix. And there is a fancier tent with a machine outside that looks like a generator. Who knows what happens in there. It feels like a million eyes are on you in the encampment.

Lessons From Street Outreach

I learned that when people donate tents to the homeless that their motivation to move off the streets dwindles. Tents lead to encampments. Economies form. They become a breeding ground for disease, rape, and violence. It isn’t safe … even for them. The best way to help? Give time or money to the agencies serving the population. They know the people. They know their issues. They know the best way off the street.

At night I go home. I lay in bed. I am grateful for the pillow under my head. For the clothes on my back. For the food on my plate. For the true basics of life. For the first responders and street outreach teams that do this every day. I revisit in my mind over and over again: the complexity of accessing services that just keeps people stuck; the limitation of resources; the policies that work both ways to help them and hurt them; the ideology that supports homeless rights vs the fight in neighborhoods for the streets to be clean and safe and how good intentions from community members to help can somehow actually hurt.

I flounder in frustration that service providers still operate independently of each other, even in the face of technology and advanced communications where data and solutions can be shared to improve the care and outcomes of the people served. A person living n the street can have five to ten agencies working with them. Does efficiency drown in silos created by funding?

And I envision creating “action at the point of contact” by bringing critical processes directly to the street, like paperwork to get IDs, so people ready to get them gain clear direction and move faster to their goal.

And then another Thursday morning street outreach comes. And I look forward to working with the team and seeing the people we have come to know who teach us every Thursday morning about life on the street.

** Houston Recovery Center is participating in a pilot program with Patient Care Intervention Center (PCIC) and Star of Hope to create a unified care plan for clients on the street. Most are being touched by multiple service agencies that do not communicate with each other. Using PCIC’s software platform, a more accurate client profile is built, next steps defined by the client is captured and can be followed by collaborating agencies. It is hoped this unified and focused approach creates better outcomes.