Podcast: JOSEPHINE ENSIGN

A Conversation with Dr. Simha Reddy

SKID ROAD
SKID ROAD
A Conversation with Dr. Simha Reddy
Loading
/

Dr. Simha Reddy is director of the Puget Sound VA Homeless Patient Aligned Care Team, where, for over the past ten years, he has done healthcare outreach and primary care with veterans experiencing or having experienced the trauma of homelessness in the Seattle area. In addition, he serves on the Implementation Board of King County’s Regional Homelessness Authority and has served on the governing board of the long-running advocacy group, the Seattle/King County Coalition on Homelessness.

In early 2017, I had the pleasure of talking with Dr. Reddy about his work. At that time, he had been working on homeless veteran health care for five years. He said, “When I took my job, actually, that was the first time I learned of the VA’s commitment to end homelessness. And I laughed because I thought it was ridiculous. After having seen what the VA has done, I think it is possible.”

A significant reduction in veteran homelessness is one of the little-known (among the general public) successes in the US response to homelessness. Beginning in 2008, the Department of Veterans Affairs and the Department of Housing and Urban Development, with bipartisan support and funding from Congress, have reduced veteran homelessness by half while overall homelessness has risen. There was a recent slight increase in veteran homelessness caused by rising rents, especially in cities like Los Angeles. But even this increase was much smaller than for other groups of people experiencing homelessness. A recent New York Times article, “Decline in Veterans’ Homelessness Spurs Hopes of a Broader Solution,” by Jason DeParle (August 6, 2024), explains all of this well. What DeParle doesn’t cover well in this article is the role of VA health care, especially community-based programs like that run by Dr. Reddy.

Housing without access to good trauma-informed primary care, including behavioral health care, will never work to reduce homelessness. VA Health provides access to comprehensive health care through its more than 13,000 hospitals and clinics nationwide. It is always imperfect, as with any healthcare system, but it is much better than the still fragmented, chaotic, and expensive US healthcare system for non-veterans. Housing First is the model of intervention used by the federal approach to reduce veteran homelessness. Housing First only works well if housing is combined with ongoing medical and social support services.

Towards the end of my conversation with Dr. Reddy he had this to say, “People sometimes have preconceptions of what a homeless person looks like, what a homeless veteran looks like. That’s it’s a drug-addicted, mentally ill, Vietnam-era veteran standing on a street corner with a sign. Maybe. But that person can get their life back together. I’ve seen that.

“But the other thing that has been remarkable to me is how close to the edge we all are. That the people I’ve cared for, all of them certainly, have been soldiers, sailors, veterans of all kinds, and have served their country, and have fallen on hard times at some point in their life by the time that I’ve seen them. But they have all been real estate agents, small business owners, cooks, priests, actually nurses, social workers.

“And what leads to homelessness is typically a crisis of some kind, and none of us are immune to a crisis. The loss of a family member. The loss of family through divorce, or something like that. A health issue. And those are the things I wish people could see; that we are so much closer to the edge than we think. But that if we live in a society where, if somebody falls over, there’s somebody willing to help them stand back up, we are going to live in a better place. That is an investment in our people. And that’s important.”

A Conversation with Hannah Glover

SKID ROAD
SKID ROAD
A Conversation with Hannah Glover
Loading
/

The best part of my job is working alongside smart, dedicated, and compassionate people who make a positive impact on the lives of people experiencing homelessness. People like Hannah Glover. She is a health navigator at the Elizabeth Gregory Home, a day shelter for women and female-identified people in the University District (U District) of Seattle. Located in one of the few remaining churches in the recently upzoned U District, Elizabeth Gregory Home is a true sanctuary for people surviving homelessness. (For a recent Seattle Times article on changes in homelessness in the U District and the roles of upzoning, see “How-and why-life for unsheltered youth on The Ave has shifted,” by Brendan Kiley.)

Think about the last time you tried to access health care, like making an appointment with a primary care provider, or for updating your vaccinations. Was it easy? If it was easy, you likely are housed, have ready access to the internet, and have a job providing decent health insurance. And you likely already have established care with a provider covered by your insurance. People who are experiencing homelessness have a much harder time with access to health care due to lack of (or confusion over) health care insurance, transportation to/from health care, lower levels of health literacy, and competing basic needs like finding shelter, food, and safety. In addition, as described in my interview with Hannah Glover, too often, a major barrier to care for people experiencing homelessness is a previous bad experience with health care. Experiences like negative stereotyping, judgmentalism, and all the ‘isms’ you can think of. Having a skilled health navigator available to people in community spaces they trust is essential.

When I provide basic health care onsite at the Elizabeth Gregory Home, Hannah Glover makes my work much more efficient and effective. The nursing students I have with me benefit from her experience and insights. We need more excellent health navigators in community settings, not just within hospitals.

A Conversation with Tim Harris

SKID ROAD
SKID ROAD
A Conversation with Tim Harris
Loading
/
Tim Harris, 2015, Photo credit: Josephine Ensign

Tim Harris, founder and longtime director (1994-2020) of Real Change, Seattle’s “street paper” anti-poverty newspaper, talked with me about his life and work in 2015. Real Change turns 30 this year, with the first issue published on August 20, 1994. My purpose with this Skid Road oral history project and podcast is to highlight and celebrate the visionary people in Seattle who have impacted the landscape locally in terms of housing and homelessness. Tim Harris is one of these visionary leaders.

A Conversation with Ginger Segel

SKID ROAD
SKID ROAD
A Conversation with Ginger Segel
Loading
/

In April, I interviewed Seattle-based housing advocate and consultant Ginger Segel. I know a lot about health policy, especially as it relates to care for people experiencing homelessness. I do not know as much about housing policy as I would like to, so I was eager to hear her stories and perspectives.

Segel first spoke of how, as a student at Columbia University in NYC, she witnessed the role of the university in displacing low-income people in the expanding area around the university. When she moved to Seattle in the 1980s, she got involved in tenant’s union organizing and in Operation Homestead. Operation Homestead’s mission was to counter the harmful effects of the closing of Single Room Occupancy Hotels (SROs) happening throughout the country. The activists occupied emptied-out buildings so that homeless and other low-income people could live there.

Segel then worked for the Low Income Housing Institute (LIHI) on establishing the consumer-led housing building, the Aloha Inn, now renamed The Inn and run by Catholic Community Services. Currently, LIHI is a major player in the Seattle-area (and beyond) efforts to provide more affordable housing to people experiencing or at risk of experiencing homelessness. Segal and other advocates helped form the state Housing Trust Fund, which, since its formation in 1986, has provided over $2 billion in capital financing to affordable housing projects throughout Washington State.

Now working as a consultant on affordable housing projects throughout the state, Segel has seen first-hand some of the drawbacks of Housing First and permanent supportive housing, including through the newly established Apple Health and Homes Initiative. I was involved tangentially in the formation of this initiative and testified in its favor (when it was House Bill #1866) before the House Health Care and Wellness Committee of the Washington State Legislature. The Apple Health and Homes Initiative pairs healthcare and housing resources for permanent supportive housing for vulnerable (and high-needs) individuals. Segel points out that we need to examine the benefits and pitfalls of Housing First closely. Communities she works with sometimes say that they are forced to take people they cannot handle and that creates safety issues for other residents and staff members.

Segel stated, “Another problem in the advocacy community is we have said we’re going to solve this (homelessness) too many time but we never could solve it because the economic forces were always much stronger than our strategies.”

A Conversation with Dr. Ben Danielson

SKID ROAD
SKID ROAD
A Conversation with Dr. Ben Danielson
Loading
/
Dr. Ben Danielson, Odessa Brown Clinic, 2015, photo credit: Josephine Ensign

I had the pleasure of working with Dr. Ben Danielson when he was the medical director of Seattle Children’s Odessa Brown Children’s Clinic in the Central District. I was a nurse practitioner at the co-located community health clinic, the Carolyn Downs Family Medical Center. I remember conferring with Dr. Danielson over the care of a young adult woman with sickle cell disease who had aged out of care at the pediatric Odessa Brown Clinic. Most of our patients were African American, Latino, and recent immigrants. Carolyn Downs Family Medical Center began as a Black Panther community clinic. Both clinics have long histories of providing quality care to people marginalized by race, ethnicity, and poverty.

Five years after I interviewed Dr. Danielson at the Odessa Brown Clinic in 2015, he resigned in protest over alleged racism towards the clinic’s patients and him by Seattle Children’s Hospital. Since then, he has helped launch a project to address the overrepresentation of Black and Latino young people, especially males, in our King County Juvenile Detention Center. This is an issue he talked about in his interview with me. “With a system that is so broken, and feeds other broken systems that fail people consistently and predictably–in other words, fail, especially young African American males–it’s hard to see yourself feeding into that. (…) Maybe our health system is set up to keep young Black males just well enough to feed them into a system of enslavement in the prison systems. That’s a heavy thing. That’s a powerful thing to think about. How much are we doing that is just supporting a process that is so harmful to so many people?”

Dr. Danielson also spoke of lessons he learned from Elizabeth ‘Liz’ Thomas, the first African American to graduate from the University of Washington’s pediatric nurse practitioner program. “When I had finished my official orientation to the job here, she (Liz) grabbed me by the ear, took me aside, and told me what I really needed to do to do a good job. And she said, ‘You have to get outside of these walls. You cannot just do medicine at the length of your stethoscope. Good care is care that happens as much for the kids who never come into this clinic as it does for the kids that do.’ More than that, she also pushed me to think a lot more about treating kids before they’re kids–pregnancy–and helping mothers have healthy pregnancies so that they have healthy births, so that they have healthy kids, and that that sequence is really important.”

Excerpts on Empathy and Homelessness

SKID ROAD
SKID ROAD
Excerpts on Empathy and Homelessness
Loading
/

This Skid Road podcast episode includes excerpts from my three books on health and homelessness. The first excerpt is from the opening of my first book, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net (2016). It has to do with my realization of my hypocrisy in terms of homelessness, of ‘coming out’ with my story of homelessness and severe depression as a young adult. The second excerpt is from a chapter titled “Walk in My Shoes” from my second book, Soul Stories: Voices From the Margins (2018). I write about empathy and homelessness and the importance of providing basic foot care to people experiencing homelessness provided by nursing and medical students. The third and final excerpt is from the opening chapter, “Brother’s Keeper,” from my book Skid Road: On the Frontier of Health and Homelessness in an American City (2021). It tells the story of Seattle’s first official homeless person, the sailor Edward Moore.

A Conversation with Charles Royer (1939-2024)

SKID ROAD
SKID ROAD
A Conversation with Charles Royer (1939-2024)
Loading
/
Charles (“Charley”) Royer, Jack Straw Cultural Center, June 21, 2017

Seattle’s longest-running mayor (1978-1990), Charles Royer, died this week at his home in Oregon. He was a good man and a good public servant. I had the pleasure of interviewing him in 2017 for my Skid Road oral history project. At that time, he was living in the Pioneer Square area of Seattle.

As a three-term mayor, Royer oversaw Seattle’s growth from a backwater town to a major city, with all of its attendant growing pains. He was mayor during our country’s wave of what is now referred to as “new homelessness.” Royer told me the story of getting to know a homeless veteran on the streets of Portland, Oregon. The man had been married with a house and a car but lost them as he spiraled into alcoholism, drinking mainly to mask the pain of a work injury in his job as a garbageman. While recounting this story, Royer teared up and said, “Damn! I didn’t see that coming. As you can see, he got to me a little bit, his story.” Royer was working on a documentary about homelessness and alcoholism. When Royer tracked this man down to ask permission to use video content about him, the man was living in the Bread of Life Mission in Pioneer Square in Seattle. The documentary Man Down won awards. It must be stored in some dusty archive in Portland.

As mayor, Royer worked on the expansion of community health clinics, low-income housing, and anti-poverty initiatives. Royer said, “It helped me as a mayor to see housing as a way out of the homelessness problem, but not the only way. You can’t build your way out of the problem of people not having shelter. People need to have options and choices of where they can stay.” Royer emphasized that people experiencing homelessness need to be known, but that law enforcement and even private non-profits, “who have become pretty big businesses now in housing in Seattle. They’ve gotten very big, very bureaucratic.” He added, “In healthcare, in housing, in shelter, in policing, in homelessness, the people doing the work need to know the people they’re working with, or they’re watching. They do a good job of watching, not a good job of knowing them. I think if you can just get a big, tough bureaucracy like Seattle’s, that would take you a long way.”

After leaving office, Royer worked for twelve years at the Robert Wood Johnson Foundation, with their demonstration project that became Health Care for the Homeless.

Part of my oral history interview with Charley Royer is included in my video, “Listening to Skid Road.”

A Conversation with Representative Nicole Macri

SKID ROAD
SKID ROAD
A Conversation with Representative Nicole Macri
Loading
/

In the midst of a prolonged heat wave two years ago in July, I talked with Washington State Representative Nicole Macri about her work on homelessness, housing justice, and behavioral health issues. Macri has worked at Downtown Emergency Service Center (DESC) in various capacities for the past twenty-two years. In the Washington State House of Representatives she serves on the Health Care and Wellness Committee.

In Seattle, as throughout much of the West, we’re in another prolonged heat wave. Excess heat is deadly, especially for the elderly, people living with mental health and substance use disorders, and people who have to work–and live–outside. People who live in isolation. Excess heat events are becoming more frequent due to the effects of climate change. When I spoke with Rep. Macri two years ago, she had visited Harborview Medical Center, our area’s Level 1 Trauma Center.

When she visited Harborview Medical Center, all the area hospitals were on alert because of the extended heat wave causing heat-related injuries. “The emergency room Medical Director said, ‘This afternoon, we had no available ambulances to go on call in Seattle because they were all at emergency departments waiting to transition their patients to the ED,’ but they struggle to do that because the hospitals are all backed up.” Rep. Macri told me that at that moment, she realized that our medical system is going through a crisis similar to what the behavioral health system has been in for years. She said, “So we have all these people who are homeless, living with severe behavioral health conditions. They are trying to get in the front door, usually through the crisis system, and the crisis system is totally overloaded and can’t respond.”

Rep. Macri went on to talk about her legislative work on community behavioral health policy and investments. “It’s a long endeavor. I knew that going into it, but it seems like every year we go back to the Legislature, we discover how a gap in the system is really profoundly harming people. It’s like a dam that’s just spurting water everywhere… And as behavioral health concerns have become more universal as more families have seen the impacts of the stress of the pandemic, there has been more of a focus on behavioral health. But we certainly didn’t have a system that is or will be anytime soon ready to respond to the growing needs we see in the community.” Towards the end of our conversation Rep. Macri added, “I just wonder and hope that we continue to have the same conversation of not making the sam mistakes; that tightening of the belt has a disproportionate harm to vulnerable communities and does not help us recover economically as quickly as investing in the communities that need the most support during these challenging times.”

A Conversation with Rex Holbein

SKID ROAD
SKID ROAD
A Conversation with Rex Holbein
Loading
/

Seattle architect Rex Holbein and I talked about his work and views on the issues surrounding homelessness. Rex founded the nonprofit Facing Homelessness in 2014 with its Window of Kindness in the University District of Seattle and the innovative BLOCK project of tiny homes. These projects still existed when I talked with him in late February 2024. Unfortunately, due to a lack of sustainable funding, Facing Homelessness closed its programs beginning in April. However, Holbein’s podcast, “You Know Me Now,” and the Circle of Ten projects he discusses in our interview continue. As Rex puts it, we have a “community crisis instead of a homelessness crisis.” All of his work around homelessness has as its core the value of community building. We discussed the ethics involved with ‘helping’ people experiencing homelessness and the importance of being honest with ourselves about why we do (or don’t do) work like his or mine–checking in on our personal agendas. As health or social care professionals, we have baked in professional norms of clear boundaries between us and our clients/patients. There are important benefits of these professional boundaries but there also are negative consequences. Rex mentioned how any person experiencing homelessness walking into most places of service knows they are “providing care to a person who is broken” and the unspoken idea of “I have, and you don’t; therefore, I’m above” hovers around the interactions.

During a time of great turmoil in our country, along with a Supreme Court of the United States-sanctioned criminalization of homelessness, the kindness, humanity, and community-building of people like Rex Holbein are more important than ever.

A Conversation with Rev. Craig Rennebohm

SKID ROAD
SKID ROAD
A Conversation with Rev. Craig Rennebohm
Loading
/

This past week, I had the privilege of participating in a panel discussion on the history and practice of behavioral health outreach, specifically for people experiencing homelessness. One of the panelists was the Rev. Craig Rennebhom, a longtime behavioral health advocate in the Seattle area. He developed and worked as a chaplain for the ecumenical companionship ministry called the Mental Health Chaplaincy, which has taken off nationwide.

The panel was for the 2024 Annual Outreach Academy, which provided training and networking opportunities for outreach workers in Washington State. It was put on by the Washington State Health Care Authority and the University of Washington Department of Rehabilitation Medicine. He had done an earlier workshop on the companionship model for outreach workers who were early in their work. Before and after the panel, I enjoyed hearing participants thank Craig for his workshop and overall work. A longtime outreach worker from the Downtown Emergency Service Center stopped to tell Craig how much his book (written with David Paul), Souls in the Hands of a Tender God: Stories of the Search for Home and Healing on the Streets. His book has been helpful to me as well in my work on homelessness over the years.

On February 2, 2016, I interviewed Craig from my Skid Road oral history project. He told me that his “deepest bias” is as follows: “My time at the hospital working with folks who were homeless and mentally ill, I realized that if we can’t bring some level of peace to our neighbors on the streets and our communities, there’s no hope for us being a more peaceable presence in the larger world. We need to learn how to be peaceable and healing at the most fundamental levels of our common life as families, neighbors, cities, and towns–communities.”