Wednesday, November 05, 2008

Sick City

Janus Youth Street Outreach Supervisor Dennis Lundberg spoke to Street Roots journalist Amanda Waldroupe this past week regarding Portland's recent Vulnerability Index survey. Here's what he had to say about the experience:

Street Roots: You were initially skeptical about the survey. Why?

Dennis Lundberg: Yeah, I was skeptical going into the survey. One of my initial problems with the survey was that outreach workers in our community were not consulted until after the City of Portland had signed a contract with Common Ground from New York. The result was that many of us felt railroaded by the request to participate in a survey that we knew little about and which seemed to fly in the face of basic outreach etiquette. A few of us insisted on a conference call with the Common Ground organizers to address our concerns about methodology and intent before we made the commitment. I was skeptical about waking people at 4am, as they did in other cities conducting the survey, and we successfully pushed the wake-up time to 6am. I was also very uncomfortable with the idea of photographing people. In general, I was skeptical that the survey might turn into a demoralizing media circus. There can be something of a voyeuristic element to doing this sort of thing and I certainly wasn't willing to undermine my credibility as an outreach worker by taking strangers into the "homes" of people sleeping on the streets.

By Thursday morning, what had changed for you?

By Thursday I was exhausted! Many of us had to continue our regular work days despite the survey so by Thursday I was really feeling worn out. I appreciated Liora Berry's insightful observation at City Hall Thursday morning that we were all feeling the effects of sleep deprivation after just a few days so imagine how folks must feel after weeks, months, and years of homelessness. I think some people had their eyes opened out there and I applaud all the volunteers and workers who participated. As for myself, I actually had fun with the survey! It just felt like another opportunity to engage and, despite the gravity of the questions, I shared some good laughs with the people I met. I can only speak to my experience but it felt comfortable and it felt compassionate. I was really struck by people's willingness to open up and share very personal information with strangers waking them up before dawn. I was also surprised by the ease with which many people allowed their photo to be taken. It would've been just as easy to refuse. One of the questions asked for an emergency contact and most people seemed genuinely touched that we would be concerned about their well-being. That's not something I ask often and it actually benefited the interactions. Most importantly I learned some things about people's health and time on the streets that should serve to further illuminate the work that needs to be done in our community. Once I got out there I realized this could be another opportunity for people to stand and be counted.

As an outreach worker, do you typically ask the sorts of questions the survey asked? Why or why not?

I never delve into people's medical history the way the Vulnerability Index did, but I think context is everything. I don't really mince words on outreach and I'll ask some pretty uncomfortable questions in the service of knowledge-sharing and understanding. For instance, when young people ask me for condoms on outreach I typically quiz them on sexually transmitted infections and I may even give them a quick harm reductionist lesson on the risks of being sexually active. I may ask them if they're involved in sex work. I often ask total strangers if they have a safe place to stay for the night and I don't mind telling people that their spider bites look like abscess infections. Those aren't easy conversations but sometimes we can do a disservice if we avoid the difficult questions.

Did you feel that the questions were an invasion of privacy? If you did, what was it like for you, as someone whose job requires being respectful and considerate to the people you work with, to ask them?

I think walking into someone's camp uninvited at 6am and waking them up is generally an invasion of privacy. As an outreach worker I think it is wise to understand this dynamic beforehand and conduct one's self accordingly. I was very conscious of how invasive the questions might be and I weighed the survey carefully before agreeing to participate. I took a leap of faith with Common Ground and the BHCD [Bureau of Housing and Community Development] that we would hopefully glean some data that might make it all worthwhile. Respect is the basic foundation of Janus Youth Street Outreach and we convey a lot with mindful body posture, voice inflection, eye contact, and facial expression. If people don't want us around, we leave. It's as simple as that. In the final analysis, if the survey serves to create resources for housing, as we've been told it has in other cities, then it might just prove to be worth the discomfort.

Did you give the survey to folks you had previously engaged with? What was that like for you? How did your relationship with the individuals change, if at all?

Both. I asked many of the young people I work with weekly to sit and do the survey with me but I also spoke to several older folks I've never met before. My team was comprised of Janus Outreach Specialists, Neal Sand and DeAnna Negrete, and we purposefully set out to some camps "off the grid" of downtown in an effort to find vulnerable people who might have been otherwise overlooked. We met some people in St. Johns that rarely leave their wooded camp who were incredibly high risk. I'm talking about IV drug users with Hep C and cancer! As I mentioned earlier, context is everything and we did our best to re-frame the survey as simply another tool for engaging with people. With the folks I've known for a while it was a great opportunity to delve deeper into questions of drug/alcohol use and mental health. I think I've been around long enough that most people trust that I wouldn't ask this stuff unless I thought it could do some good.

What did you learn from doing the survey? Were there any surprises for you?

It's funny because when we had our conference call with Common Ground I kept insisting that Portland's homeless population is quite unique and should be approached with regional sensitivity. They responded by essentially telling us that everywhere they've conducted the survey people think their city is unique but the findings are often very similar. I opened my mind to the possibility that I would learn a lot about our streets at this early hour and hoped to be proven wrong about Portland's arguably most vulnerable citizens. When the survey was over and the initial findings were shared at the Portland Building I think it was probably Common Ground who were most surprised and unfortunately it was rather grim news. No other city surveyed had as many cases of DHS/foster care involvement. No other city surveyed had as many people under 30 fall under the definition of medically vulnerable. Despite Portland's laid-back reputation, our rates for violent attacks on the homeless were higher than New York and Los Angeles! Frankly, that even surprised me.

What do you think the results of the survey convey? What should the City and housing bureau do in response to the results? What do you think of what seems to be the reaction they will move forward with--rapidly housing the most vulnerable and giving them priority in housing?

The findings support what many of us have known for a long time. Mental health is a staggering and complicated issue and we do not have sufficient resources here in Portland to meet the need. If we try to house people without addressing the root causes of their marginalization, such as mental health and substance abuse issues, we are setting them up to fail. Closely related to mental health is medical well-being and, with painfully few exceptions, most of the people I spoke with have no health insurance. Almost everyone said they seek medical attention at emergency rooms. This points to a major system failure and I'd go so far as to say that lack of affordable health care is the most immediate threat to our national security. Hepatitis C seems to be nearly epidemic on the streets of Portland so it's time to stop kidding ourselves and start rallying behind harm reduction and needle exchange programs. We really need to invest in our young people at a very early age. The huge rate of foster care involvement among the homeless indicates that we need to work together as a community to support healthy families from the start or we are simply creating the next generation of homeless citizens. Incidentally, the war overseas is daily creating our next generation of homeless citizens and the longer the war continues the more we should brace ourselves for the fallout here on the streets.

For more information about Portland's Vulnerability Index check out the latest issue of Street Roots.

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