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A homeless man sleeps on a bus stop bench on a cold night in February, 2006.

Paul Wellman (file)

A homeless man sleeps on a bus stop bench on a cold night in February, 2006.

The Homeless Count

Population Survey Carried Out by Volunteer Groups

Thursday, May 12, 2011
By Isabelle T. Walker

No one could miss the hum of anticipation in the room that Sunday in late February. Hundreds of people from across generations gathered at tables that filled the giant Earl Warren Hall. Never mind that it was beautiful outside; the buzz was all about getting up at 3 a.m. the next day to begin a momentous three-day survey of the homeless. Among the all-volunteer crowd were retirees, teenagers, church members, and the formerly homeless. A similar scene was playing out in the North County.

In a time of high economic anxiety, such altruism was surprising. But there everybody was, receiving instruction on how to interview street homeless people and getting to know their teams.

Kent at Chase Palm Park.
Click to enlarge photo

Paul Wellman

Kent at Chase Palm Park.

It’s been nine weeks since that day, and though the excitement has dissipated, the results of all that good will are tangible. At a public briefing Monday, May 9, the results of the 1,143 surveys taken during Registry Week were announced. The briefing also launched the second phase of the campaign, when organizers will begin to find homes for the most vulnerable people surveyed — the ultimate purpose of this effort.

But the data gleaned from the surveys did not, in the end, reveal startling new facts about our homeless population. It did confirm trends that our Public Health officials had found in earlier studies: that the majority of the homeless in this county are male, middle-aged, and burdened with multiple chronic illnesses; that a majority (57 percent) have a mental illness, and 77 percent have spent time in jail in the past year. Of those surveyed, 932 were found to be at risk of premature death based on a scoring system created by Boston-based physician Jim O’Connell, MD, and tweaked by the medical director of Santa Barbara’s Health Care for the Homeless program, David Lennon. The person at the top of the list — a woman who’s been on the streets 16 years and has cirrhosis of the liver, hepatitis, schizophrenia, HIV, chronic obstructive pulmonary artery disease (COPD), and is an alcoholic — has the highest vulnerability score of all.

Barry K., 62, showing where doctors at Cottage Hospital installed a pacemaker after he had a heart attack last winter. A recovering alcoholic who has worked for years as a cook, he does not consider himself homeless.
Click to enlarge photo

Paul Wellman

Barry K., 62, showing where doctors at Cottage Hospital installed a pacemaker after he had a heart attack last winter. A recovering alcoholic who has worked for years as a cook, he does not consider himself homeless.

The piece of data that is new, and that will be a source of controversy, comes from the question of where people came from and if they were homeless in that place, too. Of those being queried, 44 percent reported being from out of town, and 55.7 percent were residents here before becoming homeless. Of those who came from other places, 5 percent said it was the promise of services that drew them.

As Doctors Without Walls-Santa Barbara Street Medicine founder Mimi Doohan said recently, no matter what evolves from this campaign, no matter how many or how few receive housing in this effort, our community is forever changed. We know how to come together. We’ve done it before.

How did it coalesce, after all? What spell did organizers cast to inspire so many?

Spark to the Flame

Last July, at the annual Health Care for the Homeless (HCH) conference, Doohan and Ralph Barbosa, who runs the HCH program here, heard Becky Kanis, a former Army Special Operations communications specialist who had just launched a campaign to house 100,000 of America’s chronically homeless in three years. Kanis’s campaign was targeting 55 American cities because of their known high numbers of the chronically homeless. Santa Barbara was one of them. Doohan approached Kanis later to introduce herself and invited her to bring her campaign to Santa Barbara.

Über charismatic, smart, with the unassuming confidence of a true public servant, Kanis, a West Point grad with short, bleached blond hair, is just the person to pull off something as audacious as this 100,000 Homes effort.

Michael Silvas, who works with art, said he “was the first person to take the Common Ground survey.”
Click to enlarge photo

Paul Wellman

Michael Silvas, who works with art, said he “was the first person to take the Common Ground survey.”

In 2005, Common Ground, a New York City-based nonprofit dedicated to ending homelessness, hired Kanis to lead a new project that was trying to move the homeless in New York’s Times Square into housing. Kanis began rethinking the tired assumptions about the chronically homeless and the easy acceptance of their refusals of services — including housing. She employed motivational interviewing and eliminated middle steps in order to prevent sending people to shelters where they were often required to become sober. She offered the homeless keys. In five years, 85 percent of Times Square’s homeless were housed. Many were accessing treatment. New York City officials asked Kanis to take her approach to other neighborhoods. Soon she was getting invitations from officials in Washington, D.C., and Baltimore.

In every community, her approach is the same: Exclude no one. Every nonprofit, faith community, government agency, and lowly volunteer that wants to join the effort is welcome. Her results are as tantalizing to city administrators guarding general funds as they are to church-goers looking to live out scripture.

Last fall, a three-part series in the Los Angeles Times on the 100,000 Homes campaign that had launched in L.A. caught the attention of Rob Pearson, executive director of the Housing Authority of the City of Santa Barbara. Intrigued, he sent the story around to his staff and a few elected officials, including Mayor Helene Schneider, indicating he hoped to incorporate these ideas in his homeless projects. Soon he discovered that Doohan and two of the smaller homeless outreach organizations — the Organic Soup Kitchen and the Uffizi Mission Project — were already mapping a strategy for bringing the campaign here.

Seann Sinclaire, a nature photographer, has lived in his van in Santa Barbara for four years.
Click to enlarge photo

Paul Wellman

Seann Sinclaire, a nature photographer, has lived in his van in Santa Barbara for four years.

Ultimately, Kanis was invited to Santa Barbara for a series of five visits. She talked about lessons and successes of communities like D.C., San Diego, Omaha, and dozens of others. Soon, not only Pearson but also Casa Esperanza executive director and Ten Year Plan cochair Mike Foley were brought on board. Foley’s participation was key. The pull that he and Pearson have with elected officials broke the campaign open by linking it to the county’s biennial Point-in-Time count of the homeless. This countywide count, required by the federal Housing and Urban Development department in order for a county to receive essential Continuum of Care funding, was to take place in late January anyway. Linking the two surveys meant the county would also be backing 100,000 Homes, and the scope of its data would be broader and deeper.

When Kanis addressed the important gathering of South County homeless advocates, who have been gathering at Chuck Blitz’s beach house for years, she showed a short movie describing the campaign’s three basic stages: registry week, housing, and support. They asked questions, but by the time it was over, the only query left was when it would begin.

By the first week in December 2010, the 100,000 Homes project in Santa Barbara was endorsed by every homeless agency, public and private, in the county, and that’s how Common Ground Santa Babara was born.

By Paul Wellman

Gator, a longtime Santa Barbara figure, who has joined a sobriety program.

Rallying the Troops

“If all 55 of our targeted cities wanted us to come visit five times before inviting us in and then coming together like Santa Barbara did, I would be thrilled to death to do it,” said Kanis.

The South County’s leadership team consisted of Jeff Shaffer of the Uffizi Mission Project and Rob Fredericks and Alice Villarreal Redit of the Housing Authority. In the North County, it was led primarily by Sylvia Barnard, executive director of Santa Maria’s Good Samaritan Shelter. Since the meetings with Kanis, the Santa Barbara City Housing Authority had begun lending its credibility to the campaign and signaling to other agencies and elected officials that this was a good thing. Shaffer, who has run a weekly potluck dinner in Pershing Park for four years, has a deep Christian ethic and as much credibility with the homeless as anybody. His ties to Westmont gave the campaign a pool of energetic, sincere volunteers. It was a quietly powerful team.

Sarah Workneh, 18, has been traveling around the country.
Click to enlarge photo

Paul Wellman

Sarah Workneh, 18, has been traveling around the country.

January and February were consumed with planning. Volunteers had to be recruited, logistics centers had to be found. But the most difficult job was mapping where the homeless would be found. That was given to Shaffer. The people who knew where the camps were weren’t always willing to share the information. It took negotiation, and patience. Finally, the survey itself needed to be fine-tuned to the nuances of Santa Barbara’s homeless population, a job only Dr. Lennon could do. He examined the causes of death of the 45 homeless people who died between January 2009 and March 2010, and concluded that certain health conditions needed to be included, or given more weight: for example, cardiac disease and hypertension, heat-related injuries, and untreated HIV. In the deaths of homeless people in 2010, seizure disorders were the ninth most prevalent condition. Lennon adjusted the scoring as well, giving a higher vulnerability score to veterans, as many here have a mental illness. In the end, he wrote the database that sorted and calculated the survey results, inputting 248,000 data points. (See sidebar “Survey Results.”)

This population is notoriously hard to quantify, of course. And there are likely many more who were not contacted.

What, then, is gained from the effort, in addition to the opportunity to get people off the streets? A clear-eyed portrait of the liabilities of this population. An understanding of why they seem to die so frequently. For a time this winter, it was almost one person each week.

Tim has been traveling around the country.
Click to enlarge photo

Paul Wellman

Tim has been traveling around the country.

In the end, 932 of those surveyed were found to have an elevated mortality risk. Of them, 20 percent reported having a physical disability, 23 percent a traumatic brain injury; 51 percent are alcoholics, and 42 percent have some other addiction.

In 2008, the ACLU sued the City of Santa Barbara. In a settlement, the city agreed to create a list of the 50 most disabled homeless people and to offer them housing. If the person refused, the city was free to cite the individual for illegal camping in public. The city’s Housing Authority only recently received this list, which will be combined with the list Common Ground created through the surveys.

Councilmember Dale Francisco, who publicly worries that Santa Barbara’s services attract a great number of homeless, said recently that it remains to be seen how all of it will be utilized. “[It’s a] one-shot deal to give us some information about the current status,” he said. “In the long run, what we need is a way of tracking all of the contacts with homeless people.”

By Jen Villa

Steve attended a Milpas Community Association meeting at the Santa Barbara Inn.

Moving In

Amazingly, seven of the top 100 most vulnerable homeless have already been housed. Their names were on other Housing Authority lists, in addition to being surveyed. One of them had been on the streets for 40 years, said Fredericks. Shaffer, Villarreal Redit, Fredericks, and Barnard are hoping to house 100 within a year. But Pearson is concerned peoples’ expectations will be raised too high, given the historic problem of limited housing stock in Santa Barbara. After inventory, the next biggest challenge will be supportive services — helping people stay in housing with supports like counseling, addiction treatment, and case management. These will have to be paid for, though Doohan’s group is coming up with a plan for volunteers to help with this, too. Fredericks will be challenging faith communities to sponsor rental subsidies. Villarreal Redit is creating a “Sponsor a Room” campaign. And the Housing Authority will soon convene a meeting of top nonprofit housing providers in the county to discuss units.

“What we have to do is free up units,” said Fredericks.

As of Friday, the 100,000 Homes campaign had housed 7,867 chronically homeless Americans in 83 cities and towns across the nation. Kanis just completed a second boot-camp training in Glendale, preparing 11 more communities to launch their Registry Weeks. The campaign is catching on.

Ronnie Costa, 35, was one of the South County team leaders. He was assigned to the railroad tracks on the Westside. There were six on his team, including a nurse, two middle-aged mothers, and a retired couple in their seventies. They left the logistics center at 4 a.m.

Dilbert was diagnosed last year with advanced basal-cell carcinoma by street medical workers. He created a covered buggy to sleep in that has kept him dry in the rain.
Click to enlarge photo

Paul Wellman

Dilbert was diagnosed last year with advanced basal-cell carcinoma by street medical workers. He created a covered buggy to sleep in that has kept him dry in the rain.

“Once we got out there, it was so amazing. Everyone was so involved; everyone was excited.” They climbed two chain-link fences. Costa put people up on his shoulders to help them over. One of the volunteers, Suzanne Riordan of Families Act! found herself volunteering next to an old friend. “Both of our sons spent time homeless together by the railroad tracks,” she said. And both died tragically of drug overdoses in separate incidents.

The group walked about two miles in the dark and, in three mornings, got 16 surveys completed. Some of the people were angry at being awakened, had assumed the surveyors were police, and told them to “keep moving, keep moving.” No one turned Ken Williams, a longtime social worker, down for a survey. But he did remember one man, on the second day of surveys, who began to cry profusely right after the questioning began. “He just broke down,” said Williams.

Costa is one who won’t soon forget the experience. “What will always stand out about Common Ground [Santa Barbara] is the way everybody came together.”

Survey Results

Common Ground Santa Barbara Assesses the Population

Of the eligible 932 homeless people surveyed, 680 were male, 251 were female, and there was one transgender person.

Equipped with clipboards, bottled water, and granola bars, Common Ground Santa Barbara volunteers fanned out over the county in the early mornings between February 28 and March 2. From Rincon to New Cuyama to the Lompoc river bottom, they looked high and low for homeless people to survey. Ultimately, they made contact with 1,536 unhoused souls. Of these, 1,143 agreed to take a survey designed to measure their mortal risk.

Of those who completed a survey, 932 were found deemed at risk of premature death. There were 680 surveys from males, 251 from females, and one transgender person was surveyed. Of the cohort, 270 were living outside; 291 lived in shelters, 138 in a vehicle, 46 doubled-up, 35 in a single-room-occupancy, 117 in transitional housing. There were 22 people who reported living in some “other” situation — most likely a garage, abandoned building, or motel.

Of the surveyed, 143 were veterans (15 percent). Of the vets, 98 (or 60.5 percent) reported having a mental-health diagnosis. New research into homeless vets finds that if they have a mental-health diagnosis, their risk of dying is higher. Since so many Santa Barbara vets are mentally ill, the county health department’s Dr. David Lennon gave the entire category of homeless vets extra weight in the scoring system.

A special family survey was designed, too; 134 families took it and were deemed at high risk. The surveys found that 75 percent of homeless families live in North County; 24 families (25 percent) live in shelters, 23 doubled up (17 percent), and three (2 percent) live on the street.

The average age of all the people surveyed was 41, and the average time spent in homelessness was seven years.

The surveys found Santa Barbara’s homeless to have physical and mental conditions, just like homeless folk everywhere. Many had more than one of the conditions listed below; some had three or more.

Liver Disease: 13%
End-Stage Renal Disease/Kidney Failure: 5%
HIV: 1%
Treated HIV: 33%
Alcoholism: 51%
Drug Addiction: 42%
Mental Illness: 57% (Serious Mental Illness: 35%)
Physical Disability: 26%
Diabetes, Type 2: 8%
Tuberculosis: 3%
Treated Tuberculosis: 45%
Hepatitis B or C: 45%
Treated Hepatitis B or C: 16%
Traumatic Brain Injury: 23%
Coronary Artery Disease/Hypertensive Disease: 29%
Chronic Pulmonary Obstructive Disorder/Asthma: 25%
Cancer: 6%
Seizure Disorder: 12%
Chronic Pain Syndrome: 31%
Cold-Weather Injury: 8% (Cold Injury Treated in Hospital: 22%)
Heat-Related Weather Injury: 12% (Heat Injury Treated in Hospital: 9%)
Violence or Trauma: 33% (Police Reported: 8%)

S.B. Health Care for the Homeless medical director Lennon, pulling from new research, created a scoring system specific to Santa Barbara’s homeless population and determined that some conditions would trigger a higher vulnerability score. In addition to veterans receiving an additional point on this scale, patients with untreated HIV did also. People who were homeless and older than 50 or living outside got an extra point. Alcoholics or substance abusers who’d experienced violence or trauma also got a higher rating. Lennon based his scoring system on data he got from a specially designed vulnerability index survey administered at November’s Project Healthy Neighbors fair. That annual event screens the homeless population countywide for infectious diseases, and provides preventative care, before they enter crowded winter shelters. Roughly 600 homeless people participated in that survey, giving Lennon another window into the unique health liabilities of Santa Barbara’s homeless residents.

For more information on the Common Ground survey, go to commongroundsb.org, or log onto the author’s Santa Barbara homeless blog at homelessinsb.org. The results of the survey will also be posted on the county’s Department of Public Health Web site, at countyofsb.org/phd.

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