I am so grateful to have met and worked with Nanci Amidei, social worker extraordinaire, for several decades in Seattle. I first met Nancy when I interviewed for my job at the University of Washington (UW) in 1993. She had just started the University District Partnership for Youth (PFY_, a monthly conversation, planning, and advocacy group for teens and young adults experiencing homelessness in the U District of Seattle. Young people, service providers, sometimes community police officers, and a few people from the UW met monthly at the UW School of Social Work where Nancy worked. At the time, I was living in Baltimore City, working on health care with teens experiencing homelessness. At my first PFY meeting, I was hooked on Nancy’s optimism, pragmatism, kindness, and positive energy. She is a big reason why I accepted the UW job.
On June 16, 2015, I sat down with Nancy to interview her about her life and work. She began with the story of what got her involved in homeless youth issues in the U District soon after she moved from Washington, DC. Josephine Archuleta, a fierce advocate for people experiencing homelessness and poverty, walked into Nancy’s UW office one day and said, “The University of Washington is the biggest neighbor in the neighborhood and when it comes to homelessness, you people aren’t even at the table.” That conversation led to Nancy’s establishing the PFY and many other programs benefiting homeless youth, families, and adults.
In my interview, she discussed her twenty-five-year career in various political jobs in Washington, D.C. She helped fight back against the Reagan administration’s attempt to declare ketchup a vegetable for school lunch programs. She worked on poverty and hunger issues before moving to Seattle, where she still lives. Of homelessness in Seattle, she said, “Housing is a human right. People should not have to live on the streets. We should not be so concerned about judging people. We should be more concerned about housing people.”
Bonus interview content: Nancy’s advice on advocacy 101 and her telling of the political classic, The Butter Story.
And here are more of my photos of Nancy in action:
On October 6, 2023, I spoke with the Rev. Bill Kirlin-Hackett about his work on homelessness in the Seattle area. His advocacy and program work, especially for vehicle residents, began in 2001 and continues today. He is the director of the Interfaith Task Force on Homelessness. He spoke with me about the various renditions of the 10-Year Plan to End Homelessness, his work on the Scofflaw Mitigation Program (vehicle residency outreach) that he co-founded in 2011, his work on Safe Lots Programs and vehicle outreach programs, including at U Heights, and his work with various leaders of faith-based communities on a more compassionate approach to homelessness. Kirlin-Hackett highlights compassion, charity, and justice as all three being necessary to counter what he views as the “contempt for humanity” that prevails among many elected officials and the general public. He calls on all of us to “affirm your gift” and work to do what we can to ameliorate the suffering of people surviving (and too often not surviving) homelessness in our midst. I’ve talked with other people recently who have been working on homelessness in our area for a long time. Along with them, Kirlin-Hackett asks what it will take to create the political will to end homelessness.
David Bloom is a retired Baptist minister who headed the urban ministry of the Church Council of Greater Seattle (1978-1997). He fought bank redlining and the destruction of low-income housing. He was a founder of the Downtown Emergency Service Center (DESC), Common Ground, and the Seattle Displacement Coalition.
I talked with Bloom recently about his life and work related to poverty and homelessness. He said, “Homelessness is simply a symptom of the larger systemic problems. It’s the most dramatic manifestation of poverty.” He quoted an early director of DESC as saying, “Homelessness in America is a growth industry.” Bloom added, “And that was forty years ago, and nothing, nothing has turned that around. … It’s a growth industry because we don’t care about poor people.” I commented on the sense of despair in his voice. Contrary to common perception, despair is only opposed to one sense of hope, that of hopefulness. Despair is compatible with hoping. (That’s from my own reflection and research into despair after our conversation. Cursory, at best, but it seems to be important to parse out for ourselves.) Bloom also said, “In the course of my activism, if there was any success, it was to ameliorate the pain, to mitigate problems. … You and I both know that the problem of homelessness, lack of affordable housing (it’s) now worse than it’s ever been.”
David Bloom recalled the leaders of Seattle calling for an effort to “house elephants in the zoo–don’t we need housing for people?”
On May 29, 2024, I had the pleasure of sitting down with Sparrow Etter Carlson to discuss her work and perspectives on homelessness in Seattle. Sparrow now works for the King County Regional Homelessness Authority in sub-regional planning for Seattle. She is co-founder of the former Green Bean Coffee Shop, Aurora Commons, the SHE (Safe, Healthy, Empowered) Clinic at Aurora Commons, and the founder of Sacred Streets. She describes these as a way to “build a bridge across otherness.” The SHE clinic is for female-identified people who sleep and work along Aurora Avenue and is run by the University of Washington Medicine/ Harborview Medical Center. The clinic has expanded and includes a full-time nurse at Aurora Commons.
Sparrow is committed to encouraging each other and facilitating “deep conversations across the political divide.” She states, “I’m not a pessimistic human. Pessimism is a privilege. We have a real need, especially in this city, to focus on possibility–to be really honest about where we’re at–there’s a lot we can do with the resources we have–and I think pessimism truly gets in the way of us collaborating towards future possibility.” She encourages us all to bear hope: “I think hope is a discipline.”
She talked about being in meetings recently to interview and hire a new CEO for the King County Regional Homelessness Authority. This position has been difficult to fill for various reasons, including our Seattle-area propensity to complicate decision-making by having a multitude of process-heavy committees. Sparrow described her current sense of “exhaustion and tenacity,” adding “the deep commitment we have here; we must encourage each other.”
I have had the pleasure of working with amazing people in the various Healthcare for the Homeless community clinics over the four decades of my career as a public health nurse/family nurse practitioner. Physician Assistant and former military nurse Mark Aytch is one of these people. Especially on this Memorial Day weekend, I want to call out a compassionate and committed veteran. Mark was a military nurse on three tours of duty in Rwanda, the First Gulf War, where he was stationed in Kuwait, and then in Bosnia. He returned to the US, settled in Seattle, and worked as a nurse and then PA in our area VA hospital before focusing on care for people experiencing homelessness and extreme poverty. I worked with Mark at the 45th Street Homeless Youth Clinic where I volunteered and then worked as a nurse practitioner for sixteen years.
When I interviewed Mark on March 22, 2017, we worked together at the youth clinic. The t-shirt he is wearing in this photograph represents some of his work as an activist, in this case, the No New Youth Jail movement–advocating for a different approach to the then-large King County Youth Detention Center with its overrepresentation of Black young people. Too many of the young people we worked with in the clinic cycled between homelessness and detention. Too many of them were recruited from the streets into active duty, only to return to the streets but now with significant PTSD and physical injuries. I’ll never forget the evening one such homeless young man came into our clinic clutching a note from the VA documenting his head injury but saying they couldn’t provide follow-up medical care–could we please help him. Heartbreaking and infuriating.
Of his early work, Marck stated, “I started working at the VA Hospital. There’s lots of crossover between the homeless community and the veteran community. And I was seeing Vietnam vets with poorly treated or untreated posttraumatic stress disorder walk out of my office just as I was seeing, you know, 21-year-old Iraqi vets walk into my office with poorly treated or untreated PTSD.”
Homelessness rates among US veterans have been a national disgrace for a long time, all the way back to the Civil War. During President Obama’s two terms, he made housing veterans and providing better healthcare through the VA priorities. The Department of Veteran’s Affairs began specialized homeless programs, including in the Seattle area. As a result, homelessness among veterans was reduced but has begun to creep back up since the COVID-19 pandemic.
Mark ends his interview by saying, “My patients often say they feel invisible. I wish more people would just say ‘hi,’ or say ‘no, I don’t have money,’ But don’t ignore them.”
“I never took other people’s situations as my own. In a sense, I’ve always been able to maintain a certain level of detachment. I think it’s unfair to usurp the pain of other people’s existence–it’s theirs–and me crying about it isn’t gonna make much difference.”
Longtime public health nurse Heather Barr said this in an interview I did with her on October 27, 2015. She talked about her path from hospital-based nursing to public health nursing, working in jail health, then as a TB control nurse with Public Health–Seattle & King County (PHSKC), and then with the Health Care for the Homeless (HCH) Network program within PHSKC. When I talked with her, she was working as a consultant with HCH on best practices for communicable disease control and trauma-informed care in homeless-serving agencies throughout King County. She described the high noise levels in many such agency buildings and how that added to stress for the people being served and for frontline workers. “Looking at environments (for people experiencing homelessness) and seeing how do we really replicate or reflexively make environments look like prisons.” When she began her work as a public health nurse in the early 1980s she says that it was a stated purpose of many shelters to be as harsh, uncomfortable, and uninviting as possible with the idea that that would force people to ‘move on.’ That if the shelters were too comfortable, people would “opt into homelessness.” She pointed out that helping people feel safe and supported was more likely to help them want more of that and consider other options for health, housing, and social support.
In a week here in Seattle/King County, when the King County Regional Homelessness Authority released the 2024 ‘homeless count’ for our region, with homelessness being at the highest number ever recorded 16, 385 people), alongside Seattle mayor Bruce Harrell calling for funding cuts to reduce the number of shelter beds, I hold onto hope by remembering the compassionate and evidence-based work of people like Heather Barr. We know what works to reduce the rate of homelessness significantly, but as a city, county, and country, we don’t seem to have the sustained will to make that happen.
This past week, I had the pleasure of sitting down with public health nurse Jody Rauch to talk about her work as a direct-service public health nurse and a policy/systems change advocate for people experiencing (or, as she says, “surviving”) homelessness. She talks about the path that led her to her current work as Senior Program Manager for the Seattle/King County Coalition on Homelessness. I love how she stated that she didn’t listen to nursing instructors when she was in her BSN program who told her she couldn’t go directly into public health nursing upon graduation. She credits the wise mentoring she received about this from Dr. Maggie Baker (a trusted friend and former colleague of mine). Nursing students whose heart is in community/public health nursing should absolutely consider going directly into jobs in that field upon graduation. Please don’t listen to the nay-sayers you may encounter!
Jody stated, “I really think homelessness is just where the failures of systems, and either good or bad public policy impacts, really converge. And I wanted to be able to work and participate in trying to shift systems.” She talked about what is going on in Burien, where she lives. “Right now the Burien City Council in particular has chosen to criminalize homelessness.” She speaks up at City Council meetings and advocates against the cruel effects of sweeps and other bans on people surviving homelessness. It’s important to note here that places like Burien that criminalize homelessness cause more pain and suffering, prolong homelessness, and lead directly to an uptick in hate crimes against people “appearing” to be homeless. Unfortunately, this includes verbal and even physical attacks on official outreach workers (and public health nurses) in the field who are connecting people with needed health and social services, including behavioral health and housing options.
Finally, Jody spoke of success stories, positive programs, and public health/social service interventions, especially ones we learned locally due to the COVID-19 pandemic response impacting people living homeless. It is important to emphasize, celebrate, and support evidence-based programs, including multidisciplinary outreach teams like REACH (Evergreen Treatment Services) and the U Heights Vehicle Outreach Team.
In honor of National Nurses Week, I want to highlight interviews I’ve done with some amazing nurses working on health and homelessness issues in the Seattle area. I had the pleasure of working with Eric Seitz, RN, when he was completing his BSN nursing degree at the University of Washington. He was the class president. I interviewed him right after graduation. He spoke of his own journey through homelessness and heroin addiction on the streets of Seattle when he was a teen and young adult. About how he almost died on the streets from a “flesh-eating” bacterial infection in his leg. About his two-month stay at Harborview Medical Center and the role of nurses and others there who provided quality and compassionate care. About his decision to turn his life around with the help of friends and family members–to become a nurse to help other people living in addiction and homelessness. And to work as a street medic to provide first aid at protests and to help “spread calm.”
Almost ten years after graduating, Eric has worked as a public/community health nurse in the Seattle area. He worked for a while at Harborview Medical Center, a place he credits with saving his life. He worked as a “HOTT Nurse,” (Housing Health Outreach Team). And he has worked as the head admissions RN at one of our too few low-barrier substance use detox and intensive inpatient facilities. He is doing amazing work. As he says, he can “empathize with all the suffering.”
On June 24, 2022, I sat down with Noah Fay, director of the Downtown Emergency Service Center (DESC) Housing Programs, at the DESC building in Pioneer Square. We discussed his work, first as a volunteer at DESC, then as an outreach worker, and now in DESC administration overseeing all of their varied housing programs. That morning, I had walked past tent encampments on the sidewalk just north of DESC. Noah talked about his nuanced views of encampment clearances (sweeps), encampments that grew exponentially in Seattle during the COVID-19 pandemic. Noah said, “I am not a fan of sweeps, but I am not a fan of simply saying, ‘We need to leave people where they are and leave them be.’ Neither of those are good alternatives and neither of those are informed by what we know works for people. Sweeps on their own are highly disruptive for people. (…) There’s already such a feeling of insecurity when you don’t have a place to live. Losing it time and time again is inherently pretty traumatic. (…) But I also think we’re shortsighted (…) if we are just adamantly saying, ‘No sweeps,’ and not saying what should come instead.”
Various cities around the country, including the Seattle area Burien, enforce stricter “anti-camping” bans, allowing more encampment sweeps and legal fines for unsheltered people. Many people and advocacy groups, including the National Health Care for the Homeless Council, point to the mounting evidence that sweeps harm people experiencing homelessness. Other groups like the National Homelessness Law Center have the campaign, “housing not handcuffs,” highlighting the fact that encampment sweeps are a form of criminalizing homelessness and poverty.
This past Monday, April 22, I conducted a workshop on homelessness in a large medium-security correctional facility in a rural area of Washington. The forty-five men who attended wanted to discuss the just-opened Supreme Court case, City of Grants Pass, Oregon v. Johnson, which will decide whether laws regulating camping on public property constitute ‘cruel and unusual punishment’ prohibited by the Eighth Amendment. Many of the men had experienced homelessness and had family members still living on the streets. Obviously, they were in prison for other crimes, but homelessness had complicated their lives. They asked me for resources on re-entry programs for when they are released from prison to reduce their chances of becoming homeless and churning through the homelessness, jail, and prison pipeline. Through the librarians at the facility, I was able to provide some of these resources. The Central Library of Seattle Public Library has a list of re-entry services, as does the Emerald City Resource Guide from Real Change. Seattle University’s Homeless Rights Advocacy Project, which advocates for legal and policy changes to prevent homeless people from entering the criminal justice system, also has a list of sources. My experience with the men at the prison made me even more grateful for the dedicated work of people like Noah Fay in providing compassionate, evidence-based housing and support services in our region.
Social worker Krystal Koop talked with me about her lived experience of homelessness as a young teenager, her work in homelessness, harm reduction, and criminal justice. Krystal helped start the University District Street Medicine Project (UDSM), a University of Washington interprofessional student-run organization that still operates today (and for which I am a huge fan and faculty preceptor). This conversation occurred in the summer of 2015. Today, Krystal Koop works as a grief counselor. She talks about her first-hand experiences trying to work within broken systems, including child protective services, behavioral health, and the carceral system (and our continued and increasing criminalization of homelessness). She speaks to the importance of working with people currently or formally experiencing various forms of homelessness, with community-based frontline service providers, and providing interprofessional “learning by doing” opportunities for our health science students. This interview mentions the nurse-led Housing Health Outreach Team (HHOT) and the Downtown Emergency Service Center’s housing first 1811 Eastlake, among other Seattle service providers.
