Report #10 Outreach: the first crucial step
Principle #2: “Consistent policies, procedures, and data input must be implemented across all outreach efforts. At first contact, outreach workers should introduce individuals to a Service Coordinator Specialist (SCS) to identify their needs, the services and programs available to them, and to chart a path to recovery.”
The Homeless Services Department (HSD) defines outreach as: “An opportunity for workers to connect people to housing, shelter, survival gear and resources, and essential services including healthcare and recovery programs in an effort to end their homelessness.” This is not a bad definition of Street Outreach, but the reality falls far short.
This report will discuss the practical and systemic reasons for this and recommend possible solutions.
Outreach: Two Distinct Jobs
Outreach, in its broadest sense, includes two separate roles. One is the outreach worker on the street working directly with the homeless, building trust, obtaining initial data and contact information, and encouraging them to accept services.
The second role is a quasi-office job, that of the Service Coordinator Specialist (SCS). Their role is to collect further data on the homeless individual, establish an Individual Recovery Plan (IRP), get them into the services that start them on their road to recovery, and monitor their progress.
These are overlapping functions that need close teamwork but require different skill sets and have different daily routines. There are cases where the roles may be combined, but most successful outreach work occurs when the roles are done by different, though closely coordinated, individuals. It is hard enough to find good outreach workers who can work the street; expecting them to also do consistent evaluations and data entry -- while talking to a homeless person on a cold, wet sidewalk -- is not realistic
Currently, some outreach groups have both these functions; some do not. Data collection is sporadic, and when done is often only to collect name, ethnicity, and gender. This is relatively easy to do and might meet HUD reporting requirements, but it does little to help the homeless or provide useful data to improve the system.
The Practical Challenges
In the best case, outreach workers approach the homeless on the street, assess their condition and their needs, direct them to the appropriate service providers, and enter the details of the contact into the Homeless Information Management System, later further developed by an SCS. However, there are numerous practical problems.
Many of the homeless are drug addicts, and/or have cycled through the system with no improvement in their condition. By default, an outreach worker is a representative of the system that has not helped them. It takes a high level of street smarts to connect with the homeless. This is not a job best done by someone without “lived experience” and is often best done by people who were homeless themselves (“peer specialists”).
The outreach worker needs to establish trust with the homeless person. This typically means contacts over several days, which requires that the outreach worker works in the same neighborhood and the homeless person stays in that neighborhood.
Assessing the real needs of a homeless person is short-circuited by the HSD’s Housing First/Housing Only policy. This dictates that the first thing everyone needs is their own apartment, regardless of their condition. This has caused immense problems for the housing providers, while doing little to address chronic homelessness.
While some can benefit from immediate placement into housing, the real needs of many often start with withdrawal management and stabilization, followed by intensive supported housing for a period before they are ready for their own apartment. In some extreme cases of severe mental illness, their real need is to be institutionalized.
While an experienced outreach worker may be able to identify these needs with some accuracy, they are rarely licensed to make such assessments legally.
Assuming the outreach worker has identified the real needs of the person they are working with, referring them to the appropriate service provider is a challenge. There is no system to help them find the best shelter or to check the availability of open beds. Withdrawal management beds are scarce, and some only take new patients at specific times. Shelters have different policies and reservation systems. And there is a severe lack of long-term institutional beds.
Experienced outreach workers have their own list of service providers they know, and typically have to make 3 or 5 or more calls to find a place for their homeless contact.
Recording the encounter is often problematic. It is not easy to do when it is cold and raining, you are dealing with suspicious individuals, you have others you could be talking to, or one of many other circumstances that define reality on the streets. For this reason, a crucial first step is for the outreach worker to connect the individual to an SCS.
The Systemic Challenges
An ideal system would have standardized outreach protocols and a clean path from the streets into services. Our current system in Multnomah County has neither.
The county does not conduct outreach work itself. Instead, HSD funds over 20 service providers to employ over 100 outreach workers across the county. The county’s Health Department funds more outreach workers for the Behavioral Health Resource Center (BHRC). The city’s Portland Solutions funds yet more outreach workers. Then several non-profits run their own outreach operations.
Each group has its own procedures and policies. Some do the type of outreach described above. Some only refer the homeless to their own services. Some only give out food, some give out needles, straws, tents, and tarps. Some do a mix of things. Some coordinate with SCSs, some do not.
There is little coordination and no standardization between the organizations. One organization’s outreach may or may not know about a homeless individual’s contacts with other organizations.
Assuming good outreach and that the homeless person is ready to go into services, they will encounter yet another roadblock, namely getting into the services. As mentioned above, finding a shelter bed relies on the personal knowledge of the outreach worker, if they can find an available bed at all. The same applies to withdrawal management beds or, if appropriate, housing.
Wait lists are long, and homeless individuals on the street are hard to contact when they reach the top of a list. Without somewhere to go, outreach efforts come to naught.
Proposed Solutions
We, at Portland Voice, believe that the solution to current outreach shortcomings is centralization and standardization. Current outreach workers should be required to report directly to a centralized authority with standardized data collection procedures and reporting requirements. It will require reorganizing the current outreach system so that outreach workers no longer report to 20+ different organizations, but to one county-wide outreach office. This has the advantage of building on what is already in place. However, it will require a large reorganization and a shift in mind-set for many of the current outreach workers, too many of whom work towards “harm reduction” (giving out tents and straws) rather than recovery.
An alternative solution would be to establish one or a few centralized locations where the homeless are provided shelter. At these centers, the SCSs would have the opportunity to build a relationship with the homeless individual, evaluate them, develop an IRP, refer to and monitor the provision of behavioral health services, recovery housing, and eventually permanent housing.
Centralized outreach centers have the advantages of:
Simplifying the standardization of outreach work.
Simplifying the work of SCSs, who will have a central place to find and work with clients.
Simplifying the logistics of shelter, provision of meals, and medical care for the homeless.
Making wait-lists for services much easier to manage.
Eliminating the visible blight of homelessness on our streets and helping the city recover.
Either option would be a significant improvement over the current practices.
