The Housing First approach to homelessness | Lloyd Pendleton

88,594 views ・ 2017-12-05

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What do you think would happen
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if you invited an individual who had been living on the street
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for many years,
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had mental health issues
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and was an alcoholic
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to move directly from the street
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into housing?
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We had heard this was being done in New York City,
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and it was called the Housing First model.
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We wondered if it would work in Utah.
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So to make that determination, we decided to create a pilot,
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and Keta was one of the 17 chronically homeless individuals
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we included in this pilot.
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She had been on the street for 20-plus years,
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had mental health issues
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and was a severe alcoholic.
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The first night in her apartment,
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she put her belongings on the bed
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and slept on the floor.
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The next three nights, she slept out by the dumpster
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near the apartment building.
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With the aid of her case manager,
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she moved back into her apartment
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but continued to sleep on the floor for several nights.
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It took over two weeks for her to develop enough trust and confidence
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that this apartment was hers
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and would not be taken away from her
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before she would start sleeping in the bed.
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Homelessness is a continuing challenge for many cities
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throughout our country.
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Our homeless population falls into three major categories:
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those that are temporarily homeless,
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about 75 percent;
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those that are episodically homeless,
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about 10 percent;
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and those that are chronically homeless,
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about 15 percent.
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Chronic homelessness is defined as an unaccompanied adult
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who has been continuously homeless for a year or more
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or more than four times homeless in three years
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that totals 365 days.
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This small 15 percent of the homeless population
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can consume 50 to 60 percent of the homeless resources
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available in a community.
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In addition, they can cost the community
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20,000 to 45,000 dollars a year per person
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in emergency services costs,
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such as EMT runs,
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emergency room visits, as many of you will be aware,
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addictions, interactions with the police,
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jail time.
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Simply put, this small population costs a lot.
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Based on this reality, the US government began an initiative in 2003
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inviting states and cities and counties
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to develop a plan to end chronic homelessness
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in a 10-year period.
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The state of Utah accepted this invitation,
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and I was asked to lead this effort.
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In 2005, we approved a 10-year plan,
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and 10 years later, in 2015,
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we reported a reduction in our chronic homeless population
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of 91 percent statewide.
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(Applause)
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That's amazing.
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When I began this process, and we began this process,
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I realized that I had a limited understanding of homelessness
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and the factors that impacted it,
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and that I needed a fairly major change in my belief, in my thinking,
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because I had been raised with the theory of rugged individualism
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and "pull yourself up by the bootstraps."
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That philosophy came from being raised on our family's cattle ranch
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in a small town in the western desert of Utah.
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On the ranch, you learned that nothing takes priority
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over caring for the cattle,
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something always needs fixing
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and most importantly,
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hard work makes the world right.
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It was through that lens that I would see homeless people.
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When I was a teenager, our family would go into Salt Lake City,
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and I would see these homeless people -- "hobos" we called them then --
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sitting around on the street,
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and I would think,
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"You lazy bums, get a job. Pull yourself up by the bootstraps."
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After high school, I left the ranch,
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graduated from college,
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went to work for Ford Motor Company for several years,
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then got a job at the Church of Jesus Christ of Latter Day Saints
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and moved back to Salt Lake City.
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During that employment, I had the opportunity to be loaned out
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to the state's largest homeless shelter
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to assist them in developing and improving
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their financial and management capabilities.
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While there, I became aware of a new approach
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to dealing with homeless individuals
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and drug addicts.
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It was called the harm reduction model,
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and it consisted of passing out clean needles and condoms.
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And I thought, "Now that is one stupid idea."
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(Laughter)
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"That's just going to encourage them to continue that behavior.
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Just tell them to stop."
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Several years later, I read some of the early 10-year plans
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to end chronic homelessness
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promoted by the federal government.
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As I read through those plans, and I thought,
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"Pfft! This is unrealistic.
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You can't end homelessness.
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There's too many personal choices and factors beyond our control."
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My perspective changed, however,
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when I attended a conference in 2003,
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where I learned the reason behind the 10-year plan.
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First was this small population of the homeless group
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that was 15 percent and were very expensive.
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That made sense
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for a conservative state like Utah.
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The second insight was learning about this Housing First,
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or low-barrier housing.
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There had been an agency in New York City
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that had been inviting mentally ill homeless individuals
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to move directly from the street into housing.
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And they were also allowed to continue to use drugs and to drink,
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just like we can in our homes.
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They were, in addition, offered services -- not required to use them --
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by on-site case managers
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to assist them to adjust to their new living arrangements
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and to stabilize their lives.
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They were using the harm reduction model.
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And despite my initial low expectations about hearing about this model,
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they were having an astonishing success rate:
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85 percent were still housed after 12 months.
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The third insight
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was the importance of developing a trusting relationship.
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Because of the abuse these individuals have had
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throughout most of their lives,
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they hardly trust anybody,
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and the clean needles and condoms and low-barrier housing
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was a means to begin to develop a relationship of trust.
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Vital.
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So as I flew home from this conference,
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sitting in the plane looking out the window,
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I realized that my understanding and perspective about homelessness
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was shifting.
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And as I stared out that window,
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this very strong feeling and thought came to me
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that if there's any state in the union
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that could end chronic homelessness,
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it was the state of Utah,
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because there's an underlying feeling
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and desire and willingness to collaborate to serve our neighbors,
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including those who are homeless.
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A new vision was becoming clear to me how this could be done.
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Now, those of us that attended the conference said,
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"Yeah, these models will work in Utah."
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But when we got back home, there were many who said,
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"Nah, those aren't going to work. They won't succeed here."
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But there was, however, an affordable housing organization
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who was willing to build our first 100 units.
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But they had concerns about having 100 chronically homeless people
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in one location.
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To address that concern, we decided to create a pilot
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to test that idea while we built the first 100 units.
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We would use existing units scattered throughout Salt Lake City.
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Then we debated:
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Should we select fairly high-functioning homeless persons
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or the most challenging ones we could find?
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And this is where my background on the ranch came into play.
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Back then, my mother cooked our meals
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and heated the water for our weekly bath
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on a wood-burning and coal-burning stove.
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And after chopping wood for that stove all those years,
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I'd learned to chop the big end of the log first,
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when I had the most energy.
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We decided to use the "big end of the log first" approach
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and selected 17 of the most challenging,
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difficult, chronically homeless people we could find,
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because we knew we would learn the most from them.
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Twenty-two months later,
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all 17 were still housed,
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including Keta,
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who today, 11 years later,
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is sleeping in her own bed
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and is sober.
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At the end of this pilot, one of the young case managers said,
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"We used to debate up at our university classes
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which theory of case management was the most effective.
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Now our theory of case management is:
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anything necessary to keep them housed."
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We became believers,
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and built hundreds of units over those next 10 years,
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leading to the reduction of our statewide chronic homeless population
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of 91 percent.
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Now, who are homeless people?
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Many people just want them to go away, to disappear,
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not disrupt our lives.
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Through this 10-year, 11-year process, I gained many insights
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of why people become homeless.
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One of those insights came to me a few years ago
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when I was visiting with our medical outreach team.
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These are our frontline workers
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that go out and visit the street homeless and the prostitutes
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to check on their medical health.
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One of the team members mentioned
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that eight of the prostitutes had given birth to 31 children
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that had become wards of the state.
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They also shared that some of the pimps were their husbands,
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and worse yet,
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their parents.
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These prostitutes,
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in their late teens, 20s, early 30s,
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were expected to earn enough money a day to support
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a hundred-dollar-a-day heroin addiction,
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their living expenses
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and their pimp.
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And with unprotected sex, they were paid more,
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and predictably, this would lead to a pregnancy.
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Children born under these circumstances many times end up becoming homeless.
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And it's not helpful to look at those born under those circumstances,
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or a parent that makes their child a drug addict at age seven,
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or a generation of babies born through drug addiction,
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and not feel some despair.
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For me, I believe every person is of value,
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no matter who you are.
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And it's not helpful to look at somebody with this start in life
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and blame them for where they are.
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(Applause)
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No one grows up saying, "My goal in life is to become homeless."
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And that's the beauty of the harm reduction and Housing First model.
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It recognizes the complexities of the different factors
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that can shape a human life.
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These models meet people where they are,
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not where we are
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or where we think they should be.
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The pilot we did with our 17 taught us many lessons.
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When people have been living on the street for many years,
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moving back into housing
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requires lots of things to learn.
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And Donald
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taught us some of these transition lessons.
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His case manager asked him why he had not turned up the heat
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in his cold apartment.
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Donald said, "How do you do that?"
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He was shown how to use a thermostat.
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The case manager also observed
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that he was heating the beans in the can on the stove,
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like he had done over the campfires for many years.
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He was shown how to use pots and pans.
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We also learned that he had a sister that he had not seen in 25 years,
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who thought he was dead.
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She was happy to learn otherwise,
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and they were soon reconnected.
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Hundreds of people like Keta and Donald are now housed
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and reconnecting with their families.
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Also, many of our communities are incurring
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fewer emergency services costs.
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I have learned over and over again
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that when you listen to somebody's story with an open heart,
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walk in their shoes with them,
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you can't help but love and care for them
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and want to serve them.
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This is why I'm committed
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to continuing to bring hope and support to our homeless citizens,
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who I consider to be my brothers and sisters.
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Thank you.
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(Applause)
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