The Housing First approach to homelessness | Lloyd Pendleton

譯者: Lilian Chiu 審譯者: Marssi Draw

What do you think would happen

想想下面這個狀況：

if you invited an individual who had been living on the street

如果你們邀請一個多年來

for many years,

住在街頭、

had mental health issues

有心理健康問題，

and was an alcoholic

且酗過酒的人，

to move directly from the street

直接從街頭搬入住宅中，

into housing?

會發生什麼事？

We had heard this was being done in New York City,

我們聽說紐約市已經這麼做過，

and it was called the Housing First model.

它被稱為「住屋優先」模型。

We wondered if it would work in Utah.

我們很好奇這在猶他州是否可行。

So to make that determination, we decided to create a pilot,

為了要確認這件事， 我們決定做一個試驗，

and Keta was one of the 17 chronically homeless individuals

琦塔是我們選來進行 這個試驗的十七位長期

we included in this pilot.

無家可歸者之一。

She had been on the street for 20-plus years,

她已流落街頭二十多年，

had mental health issues

有心理健康問題，

and was a severe alcoholic.

且是重度酒鬼。

The first night in her apartment,

她住進公寓的第一晚，

she put her belongings on the bed

她把家當都放在床上，

and slept on the floor.

自己則睡在地上。

The next three nights, she slept out by the dumpster

接下來的三個晚上，她睡在外面，

near the apartment building.

公寓附近的垃圾箱旁邊。

With the aid of her case manager,

在她的個案經理協助之下，

she moved back into her apartment

她搬回了她的公寓，

but continued to sleep on the floor for several nights.

但還是在地上睡了好幾個晚上。

It took over two weeks for her to develop enough trust and confidence

她花了超過兩週的時間， 才發展出足夠的信任和信心，

that this apartment was hers

相信這個公寓是她的，

and would not be taken away from her

且不會被奪去，

before she would start sleeping in the bed.

她才開始睡在床上。

Homelessness is a continuing challenge for many cities

對我們全國的許多城市而言，

街友一直是個挑戰。

throughout our country.

Our homeless population falls into three major categories:

我們的街友人口主要可以分為三種：

those that are temporarily homeless,

暫時無家可歸的人，

about 75 percent;

大約佔 75%；

those that are episodically homeless,

不定期無家可歸的人，

about 10 percent;

大約佔 10%；

and those that are chronically homeless,

以及長期無家可歸的人，

about 15 percent.

大約佔 15%。

Chronic homelessness is defined as an unaccompanied adult

長期無家可歸的定義， 是無人陪伴的成年人

who has been continuously homeless for a year or more

持續無家可歸一年以上，

or more than four times homeless in three years

或是在三年間有超過四次無家可歸，

that totals 365 days.

且總天數超過 365 天。

This small 15 percent of the homeless population

這少數的 15% 街友人口，

can consume 50 to 60 percent of the homeless resources

可以消耗掉社區街友資源的50%~60%。

available in a community.

In addition, they can cost the community

此外，他們每年每人需要社區

20,000 to 45,000 dollars a year per person

花費兩萬到四萬五千美元的

in emergency services costs,

緊急服務成本，

such as EMT runs,

比如急診醫療隊出勤、

emergency room visits, as many of you will be aware,

進急診室，就像在座很多人知道的，

addictions, interactions with the police,

毒癮、和警察的互動、

jail time.

坐牢服刑。

Simply put, this small population costs a lot.

簡言之，這一小群人花不少錢。

Based on this reality, the US government began an initiative in 2003

根據這個現實狀況，美國政府 在 2003 年開始了一項方案，

inviting states and cities and counties

邀請州、城市、郡一起加入，

to develop a plan to end chronic homelessness

發展一個十年計畫 來終結長期街友的問題。

in a 10-year period.

The state of Utah accepted this invitation,

猶他州接受了這項邀請，

and I was asked to lead this effort.

並找我來領導這項工作。

In 2005, we approved a 10-year plan,

在 2005 年， 我們核准了一個十年計畫，

and 10 years later, in 2015,

十年後，2015 年，

we reported a reduction in our chronic homeless population

我們公布的結果是， 全州長期無家可歸的人口

of 91 percent statewide.

減少了 91%。

(Applause)

（掌聲）

That's amazing.

那是很驚人的。

When I began this process, and we began this process,

當我們開始這個流程時，

I realized that I had a limited understanding of homelessness

我發現到我對於無家可歸 以及影響它的因子，

and the factors that impacted it,

了解都十分有限，

and that I needed a fairly major change in my belief, in my thinking,

我需要針對我的看法、 我的想法，做很大的改變，

because I had been raised with the theory of rugged individualism

因為我是在嚴格的個人主義理論

and "pull yourself up by the bootstraps."

和「自立自強」的觀念之下長大的。

That philosophy came from being raised on our family's cattle ranch

我們家在猶他州西部沙漠， 小鎮上有個牧牛場，

in a small town in the western desert of Utah.

這哲學來自在那兒成長的經歷。

On the ranch, you learned that nothing takes priority

在牧場學到的是：首要之務絕對是

over caring for the cattle,

照顧牛隻，

something always needs fixing

總是有什麼東西需要修理，

and most importantly,

還有最重要的，

hard work makes the world right.

努力就能解決世界上的問題。

It was through that lens that I would see homeless people.

我是從那樣的視角 在看無家可歸的街友。

When I was a teenager, our family would go into Salt Lake City,

當我還是青少年時， 我們全家會到鹽湖城，

and I would see these homeless people -- "hobos" we called them then --

我會看到無家可歸的人就坐在街上， 那時我們稱他們為「流浪漢」，

sitting around on the street,

而我會心想：

and I would think,

「你們這些懶廢物， 去找份工作，自立自強。」

"You lazy bums, get a job. Pull yourself up by the bootstraps."

After high school, I left the ranch,

高中之後，我離開了牧場，

graduated from college,

從大學畢業，

went to work for Ford Motor Company for several years,

在福特汽車公司工作了數年，

then got a job at the Church of Jesus Christ of Latter Day Saints

接著在耶穌基督後期聖徒教會 找到一份工作，

and moved back to Salt Lake City.

搬回了鹽湖城。

During that employment, I had the opportunity to be loaned out

在那段工作期間，我有機會去協助

to the state's largest homeless shelter

該州最大的街友庇護所，

to assist them in developing and improving

幫他們開發和改善

their financial and management capabilities.

他們的財務和管理能力。

While there, I became aware of a new approach

在那裡時，我發現了一種新方法，

to dealing with homeless individuals

可用來幫助無家可歸的人

and drug addicts.

及有毒癮者。

It was called the harm reduction model,

那方法叫做減少傷害模型，

and it consisted of passing out clean needles and condoms.

內容包括分發乾淨的 針頭以及保險套。

And I thought, "Now that is one stupid idea."

我心想：「那真是個蠢點子。」

(Laughter)

（笑聲）

"That's just going to encourage them to continue that behavior.

「那樣做只會鼓勵他們 繼續原本的行為。

Just tell them to stop."

應該叫他們別做。」

Several years later, I read some of the early 10-year plans

幾年後，我讀了一些資料， 是關於聯邦政府

to end chronic homelessness

早期推動終結

promoted by the federal government.

長期街友的十年計畫。

As I read through those plans, and I thought,

我讀過這些計畫的內容之後，心想：

"Pfft! This is unrealistic.

「呸！這很不實際。

You can't end homelessness.

街友問題是無法終結的。

There's too many personal choices and factors beyond our control."

它牽涉到太多個人選擇 及我們無法控制的因子了。」

My perspective changed, however,

然而，我的觀點變了，

when I attended a conference in 2003,

2003 年時我參加了一場大會，

where I learned the reason behind the 10-year plan.

在那裡，我學到了 十年計畫背後的理由。

First was this small population of the homeless group

首先，我學到這一小群的街友族群，

that was 15 percent and were very expensive.

雖然只佔 15% 但卻非常昂貴。

對於猶他州這種保守的州而言，

That made sense

for a conservative state like Utah.

那數字是合理的。

The second insight was learning about this Housing First,

第二，我學到了這個「住屋優先」

or low-barrier housing.

或低門檻住屋供給。

There had been an agency in New York City

在紐約市有一個機構

that had been inviting mentally ill homeless individuals

一直在邀請有心理疾病的街友

to move directly from the street into housing.

直接從街頭搬入住屋當中。

And they were also allowed to continue to use drugs and to drink,

他們也被允許繼續使用毒品和喝酒，

就像我們在自己家裡也可以一樣。

just like we can in our homes.

They were, in addition, offered services -- not required to use them --

此外，現場的個案經理 也會提供服務給他們──

by on-site case managers

不強迫要使用──

to assist them to adjust to their new living arrangements

來協助他們調整新的居住安排，

and to stabilize their lives.

讓他們的生活更穩定。

They were using the harm reduction model.

他們用的是減少傷害模型。

And despite my initial low expectations about hearing about this model,

雖然我一開始聽到這個模型時， 對它的期望是很低的，

they were having an astonishing success rate:

但它的成功率卻非常驚人：

85 percent were still housed after 12 months.

有 85% 的人在 12 個月之後 仍然住在住房中。

The third insight

我學到的第三點，

was the importance of developing a trusting relationship.

是發展信賴關係的重要性。

Because of the abuse these individuals have had

因為這些人在他們一生中大半時候

throughout most of their lives,

都受到傷害，

they hardly trust anybody,

所以他們很難信任別人，

and the clean needles and condoms and low-barrier housing

而乾淨的針頭、保險套、 低門檻住房供應，

was a means to begin to develop a relationship of trust.

就是開始發展信賴關係的手段。

Vital.

這非常重要。

So as I flew home from this conference,

會議結束後我搭飛機回家，

sitting in the plane looking out the window,

坐在飛機上，看向窗外，

I realized that my understanding and perspective about homelessness

我發現到我對於 街友的了解和觀點

was shifting.

正在轉變。

And as I stared out that window,

當我盯著窗外時，

this very strong feeling and thought came to me

產生了一種很強烈的感覺和想法，

that if there's any state in the union

覺得如果在美國有任何一州

that could end chronic homelessness,

能夠終結長期街友的狀況，

it was the state of Utah,

那就會是猶他州，

because there's an underlying feeling

因為在猶他州有一種很根本的感覺、

and desire and willingness to collaborate to serve our neighbors,

慾望、意願， 要同心協力來服務我們的鄰居，

including those who are homeless.

包括無家可歸的人。

A new vision was becoming clear to me how this could be done.

對於要如何做到， 我開始有個清楚的遠景。

Now, those of us that attended the conference said,

我們去參加會議的人說：

「是的，這些模型 在猶他是可行的。」

"Yeah, these models will work in Utah."

But when we got back home, there were many who said,

但當我們回到家，就有很多人說：

「不，那些都不可行， 在這裡都不會成功。」

"Nah, those aren't going to work. They won't succeed here."

But there was, however, an affordable housing organization

然而，有一個在做可負擔住房的組織

who was willing to build our first 100 units.

願意為我們先建立 100 個單位。

But they had concerns about having 100 chronically homeless people

但他們擔心把 100 個 長期無家可歸的人

in one location.

放在同一個地方會不會有問題。

To address that concern, we decided to create a pilot

為了解決他們的擔心， 我們決定做個試驗，

在建立前 100 個單位的同時 先來測試該想法是否可行。

to test that idea while we built the first 100 units.

We would use existing units scattered throughout Salt Lake City.

我們用的是散布在 鹽湖城各地的既有單位。

Then we debated:

接著，我們盤算：

Should we select fairly high-functioning homeless persons

我們應該要選擇 高功能無家可歸的街友？

or the most challenging ones we could find?

還是我們能找到的街友中 最具挑戰性的？

And this is where my background on the ranch came into play.

這時，我的牧場背景就派上用場了。

Back then, my mother cooked our meals

那時，我母親為我們煮飯，

and heated the water for our weekly bath

為我們每週一次的洗澡把水加熱，

on a wood-burning and coal-burning stove.

用的是燒木材和煤的爐子。

And after chopping wood for that stove all those years,

那些年來不斷為了爐子而劈柴，

I'd learned to chop the big end of the log first,

我學會在我還最有力時，

when I had the most energy.

就先從圓木比較大的那一端劈下去。

We decided to use the "big end of the log first" approach

我們決定使用的方法是 「先劈圓木較大的一端」，

and selected 17 of the most challenging,

在我們能找到的所有 長期無家可歸街友中，

difficult, chronically homeless people we could find,

選出了 17 名 最有挑戰性、最困難的，

because we knew we would learn the most from them.

因為我們知道， 我們能從他們身上學到最多。

Twenty-two months later,

22 個月之後，

all 17 were still housed,

所有 17 人都仍然住在住房中，

including Keta,

包括琦塔在內，

who today, 11 years later,

今天已經是 11 年後了，

is sleeping in her own bed

她現在能睡在自己的床上，

and is sober.

而且沒喝醉。

At the end of this pilot, one of the young case managers said,

在這次試驗結束時， 其中一位年輕的個案經理說：

"We used to debate up at our university classes

「我們以前在大學上課時會爭論

which theory of case management was the most effective.

哪一種個案管理理論最有效。

Now our theory of case management is:

現在我們的個案管理理論是：

anything necessary to keep them housed."

做所有必要的事 來讓他們繼續住在住房中。」

We became believers,

我們成為了信徒，

and built hundreds of units over those next 10 years,

在接下來的十年， 建立了數百個單位，

leading to the reduction of our statewide chronic homeless population

結果是將全州的長期無家可歸人口數

of 91 percent.

減少了 91%。

Now, who are homeless people?

無家可歸的人是誰？

Many people just want them to go away, to disappear,

許多人只希望他們能走開、消失，

not disrupt our lives.

不要擾亂我們的生活。

Through this 10-year, 11-year process, I gained many insights

在這 10、11 年的過程中， 我深刻理解到

of why people become homeless.

為什麼人會無家可歸。

One of those insights came to me a few years ago

其中一點是我在幾年前理解到的，

when I was visiting with our medical outreach team.

當時我和我們的外展醫療隊 一同去做拜訪。

These are our frontline workers

他們是我們的前線人員，

that go out and visit the street homeless and the prostitutes

走出去實地拜訪街友和性工作者，

to check on their medical health.

檢查他們的健康狀況。

One of the team members mentioned

醫療隊的一名成員提到，

that eight of the prostitutes had given birth to 31 children

8 位性工作者生了 31 個孩子，

that had become wards of the state.

這些孩子變成這個州要監護的人。

They also shared that some of the pimps were their husbands,

她們也分享說， 有些皮條客就是她們的丈夫，

and worse yet,

更糟的是，

their parents.

是她們的父母。

These prostitutes,

這些性工作者

in their late teens, 20s, early 30s,

接近 20 歲、 20 多歲， 或 30 初頭，

were expected to earn enough money a day to support

一天得要賺足夠的錢來負擔

a hundred-dollar-a-day heroin addiction,

一百元的海洛因毒癮、

their living expenses

自己的生活花費

and their pimp.

和給皮條客的錢。

And with unprotected sex, they were paid more,

不安全的性行為讓她們可以賺更多，

and predictably, this would lead to a pregnancy.

但也可預期， 沒有保護措施會導致懷孕。

Children born under these circumstances many times end up becoming homeless.

在這些情況下出生的孩子， 下場常常就是無家可歸。

And it's not helpful to look at those born under those circumstances,

如果不感到絕望地去看待 在那些情況下出生的孩子，

or a parent that makes their child a drug addict at age seven,

或是讓孩子在七歲 就變成毒蟲的父母，

or a generation of babies born through drug addiction,

或是染毒父母所生下的寶寶，

and not feel some despair.

那是沒有幫助的。

For me, I believe every person is of value,

對我而言，我相信 每個人都有其價值，

no matter who you are.

不論你是誰。

And it's not helpful to look at somebody with this start in life

對於人生起跑點是這個樣子的人， 去責怪他們的處境，

and blame them for where they are.

是沒有幫助的。

(Applause)

（掌聲）

No one grows up saying, "My goal in life is to become homeless."

沒有人在成長過程中會說： 「我的人生目標是要無家可歸。」

And that's the beauty of the harm reduction and Housing First model.

那就是減少傷害 和住屋優先模型的美好之處。

It recognizes the complexities of the different factors

它能認清一個人的人生

是由許多不同的複雜因子所形成。

that can shape a human life.

These models meet people where they are,

這些模型看的是那些人的處境，

not where we are

而不是我們的處境，

or where we think they should be.

也不是我們認為他們該有的處境。

The pilot we did with our 17 taught us many lessons.

我們做的 17 人試驗 教了我們許多東西。

When people have been living on the street for many years,

當人們流落街頭許多年，

moving back into housing

要搬回到住房中

requires lots of things to learn.

會需要學很多事。

And Donald

而唐諾，

taught us some of these transition lessons.

教我們去了解一些這種轉變。

His case manager asked him why he had not turned up the heat

他的個案經理問他， 為什麼公寓那麼冷

in his cold apartment.

還不把暖氣打開？

Donald said, "How do you do that?"

唐諾說：「要如何打開？」

He was shown how to use a thermostat.

這才有人教他如何用自動調溫器。

The case manager also observed

個案經理也觀察到，

that he was heating the beans in the can on the stove,

他會在爐上加熱罐頭裡的豆子，

like he had done over the campfires for many years.

就像他多年來用營火加熱一樣。

He was shown how to use pots and pans.

這才有人教他如何用壺和鍋。

We also learned that he had a sister that he had not seen in 25 years,

我們也知道他有個姐妹， 25 年沒見到了，

who thought he was dead.

她認為他已經死了。

She was happy to learn otherwise,

她很高興發現他沒死，

and they were soon reconnected.

他們兩人很快就再聯絡上。

Hundreds of people like Keta and Donald are now housed

有數百個像琦塔及唐諾的人 現在有房子可以住，

and reconnecting with their families.

並和家人重新取得聯絡。

Also, many of our communities are incurring

此外，我們許多社區要負擔的

fewer emergency services costs.

緊急服務成本也變低了。

I have learned over and over again

我一而再再而三地學到，

that when you listen to somebody's story with an open heart,

當你打開心去傾聽一個人的故事，

walk in their shoes with them,

換到他們的角度去思考，

you can't help but love and care for them

你就一定會去愛他們、關心他們，

and want to serve them.

會想服務他們。

This is why I'm committed

這就是為什麼我承諾

to continuing to bring hope and support to our homeless citizens,

要繼續把希望與支持 帶給無家可歸的市民，

who I consider to be my brothers and sisters.

我把他們視為是我的兄弟姐妹。

Thank you.

謝謝。

(Applause)

（掌聲）