99% Invisible - Chapter 4: The List

Episode Date: December 12, 2020

When Tulicia Lee tried to get help with housing, she was essentially put on a big long list with a bunch of other homeless people. If you live in the U.S., your community probably has a list like this too. Where one ends up on the list can have huge implications, but how one rises to the top of it is a bit of a mystery. In this episode, Katie finally gets to see how it works. The List The way homelessness has exploded in California over the last decade, you’d think there was no system in place to address it. But there is one - it just wasn’t designed to help everyone. According to Need is a documentary podcast in 5 chapters from 99% Invisible that asks: what are we doing to get people into housing?

Last year, when Tolisha Lee called 2-on-1, so that she and her son could get help with housing or shelter, the operator told her to go and do an assessment so that she could get into the coordinated entry system, or CES, as she calls it. Okay. So tomorrow, you can go at 1 p.m. at the Henry Robinson Multiservice Center to do an assessment for the CES program. Tullisha did that. She sat down with a social worker and answered some questions and was entered into the system, but she didn't end up getting any help with housing. I think I just feel like somebody they forgot about me. They forgot about me and my son. When Tullisha entered that system, she was essentially being put on a big long list with a bunch

of other homeless people. But what she didn't realize and what I didn't know at the time was that this list, it wasn't just a first-come, first-serve queue. It was a list of all the homeless people in Alameda County ranked according to need. The people at the top were considered the most in need of housing and they were prioritized first for help. I don't think it's hyperbolic to say that people may actually live or die according

to where they end up on this list. Homelessness is lethal. A study in Los Angeles in the early 2000s found that the average age of death for a homeless person was 48 years old, and that life expectancy is about 36% shorter overall. Housing equals more years of life, and being at the top of the list is a path to housing. I want to know why as a single mom struggling with her mental health and living in a car with her kid, Tullisha wasn't high enough on the list to get help.

Was she close or far? And if this is a ranking of needs, how are they determining who's need is the greatest? To find the answers to these questions, I'm going to take you deep inside of this bureaucracy. Like Russian nesting dolls, there's layers to this thing. But I promise we are going to solve the mystery of where Tilecia ended up on this list and why it fails so many people. This is according to Need, Chapter 4. If I wanted to know where Tleisha had been on the list, I'd need to find someone who

had access to it, who could actually pull it up on their computer screen and look at it. But that proved to be difficult. Yeah, so I found her first call that I had with her back September 2019. In my notes, yeah, Collar has been sleeping in her car with her son. This is Elsa Gonzalez. She works at 211 and she's actually the operator who told Tillyia she should go and get into the coordinated entry system. Or in other words, get on the list. And are you like, as an operator, are you able to see where she would have ended up on that list?

No. The list. I mean, today I even told someone, hey, I don't know how they prioritize the list. I don't know how they're pulling people from the list. But they get you on the list. They're very good at getting people on lists. And then all of a sudden you're not on the list or you went all the way back down to the bottom of the list.

It's all a huge mystery. You know, that list is... Yeah, so you're giving us about the power of law and legislation. I had so many conversations about the list and the bureaucracy behind it. And I hadn't found out anything specific about Tulecia yet. But one thing I learned is that the way homeless services are administered in this country is that the Department of Housing and Urban Development, A.K.Hud, gives big grants every year to nonprofits that have organized themselves into communities.

Like, for example, all the nonprofits in Alameda County are part of one group, and they share one pot of money. HUD isn't usually able to give these local communities all of the funding they apply for, because HUD itself also doesn't get all the funding it asks for from Congress. And because funding is scarce, a few years ago, HUD told local communities all over the

US, they would have to implement systems, coordinated entry systems to make sure the limited resources went to the people most in need. What this meant was that all over the US, communities like Alameda County had to make a list of all the homeless people in their particular area ranked according to need. And then figure out how to get the available resources to those people, prioritizing the people at the top of the list. Eventually, I figured out that in Alameda County, the organization that led the effort to implement the coordinated entry system was called Everyone Home. So maybe someone at Everyone Home had access to the list.

Like, someone has to be looking at this thing and making decisions about the people at the top of it, right? Hey, how are you? Katie. Julie. Nice to meet you. That's Julie, glad better.

She's since left the organization, but she used to work for everyone home and she helped put the coordinated entry system in place. This part of it is like a crucial piece which remains kind of mysterious to me, the coordinated entry piece. Yeah. Everyone's always referring to the list, right? Yeah, it feels a little bit like the Wizard of Oz. I guess my first question is, like, are you the Wizard?

Is this Oz? I am not the Wizard. This is not Oz. But I can give you the system manual, which explains the whole thing. Really? Yeah. I do have a map of Oz. Okay, can we like look at it together?

Yes. When HUD asked communities all over the country to implement this system that ranked people according to need, the question for Julie and her colleagues became, okay, who is the most in need of health? Who shall we prioritize for these very, very scarce resources? After SAMS and Barrices, very successful work with housing first, experts and policymakers started to think

that the people who should be prioritized for resources were the kinds of people SAMS had been working with. People who are often dealing with a lot of challenges, mental or physical illnesses, disabilities, addiction. These were the people that research showed were the most likely to die on the street if no one intervened. And importantly, they were also the people most likely to use costly services like shelters or detox centers or ERs.

But there was a fear that these folks weren't getting services, because they were hard to work with or had a hard time self-advocating. So, Coordinate Entry also came at a time where people said, wait, the people who really need this are not getting it. And so as the folks in Alameda County, like Julie, started to answer that question, who should be prioritized? They would have been thinking about that group, and they also asked homeless people themselves. You know, a lot of the folks that I'm struggling, but that person over there, that person needs help before I do. In the end, Alameda County came up with a vulnerability assessment, a questionnaire, basically. This was the thing Talisha had done with the social worker, where she had to answer questions like,

does anyone in your household suffer from depression or schizophrenia? Do you have a disability? Do you have any chronic health conditions? In the past 30 days, have you had to do things that felt unsafe to survive? Every homeless person on Alameda County's list has been given this same assessment and depending on how they answer each question they get a score and it's that score that determines their place on the list. So that's where you hear about the list. And the list is long right now. There are currently around 8,000 households

on Alameda County's list. A household can be an individual or it can be a mother in her kids, for example. And Julie said she thinks of those 8,000 households, only about 20% will get some kind of resource. The resources are all kept sort of on spreadsheets. And only a few hundred of those households, the ones at the very top of the list, will get the kind of housing that you heard about in the last chapter,

what's now called permanent supportive housing, where your rent is subsidized for the rest of your life plus you get access to other supportive services. There are other less intense interventions people can get, like short-term help with rent or one-time help with a deposit. But Tilecia, as we know, got none of these things. And sadly, Julie was not the person who could tell me exactly why. And so, when you're ordered on the list, that gives you a rank on this list. But then you're matching, so this is the mattress. These people out there who are doing this, by the, who are those people? They're all across the county.

These mattress, they are the people that look at the list and match the people at the top with resources like housing. I needed to talk to one of them. Oh, hi. And long story short, I had to talk to one of them. Oh, hi. And long story short, I had to send a bunch more emails, make a bunch more calls, and then, finally, I found a matcher, a person with access to the list. How are you doing? Good well. Working from home?

Yes. This is Laquishaisha livingston and she is a match. I am doing the matching and it's very unbiased as far as our work because the computer tells me it's based on a scoring system which families are higher need than other families. Lakisha works for an organization called building futures and she spends a lot of time looking at a subsection of the list that includes households with kids. When you're looking at that list all day every day, like, look at it, you kind of become really familiar with

where people are, what they rank, and it's just like mesmerizing in a sense. Not only does Laquisha look at the list, but she could tell me what Tileisha had scored on her vulnerability assessment, which is ultimately what determines how high or low she would have been on the list. This was the person I'd been looking for. I was trying to keep it cool, but I was so excited. Yeah, and is that that's part of what I was hoping you guys would share with me is so that I can understand kind of like why someone like her wouldn't have moved into shelter or housing. So I can't specifically give you her score.

I truly thought my hopes had been dashed in this moment. But then, Laquisha's supervisor who was also on the call jumped in and was like, it's cool we have permission from T'laisha to share this info. Okay, let me see here. So I'm licking at the actual assessment right now. Tulecia starts skimming through Tulecia's answers on the assessment. She has been homeless, you know, multiple times. She states that she checked mental health, chronic health conditions. All of this added up to a score of, so she was at a 120. 120. That was her a 120. 120.

That was her score on the assessment. The higher your score, the more vulnerable you're considered to be and the higher you are on the list. It's above the average range, but just not quite high enough. Like right now, if I'm looking at the list to place families, I'm not even near 120. Really? I'm still... Yes, I'm still at about 150.

There are lots of people, Laquisha says, who score 150 or 160 or 190 or higher. They just ticked more boxes on the vulnerability assessment than Tullisha. And so they ended up higher on the list than her. Disability is the big one. HIV positive is another one. Another factor that gets you more points on the assessment is the length of time homeless. Tilecia had only been in the car for a few months. Before that, she was doubled up with friends or family members, which doesn't even count as homeless, according to this system. There were such limited resources, and so many people considered more vulnerable than Talicia that she just never made it down to the still vulnerable but not vulnerable enough. 120's. It's devastating sometimes because you want to help and you know we have programmatic

rules that we have to follow so it's just one of those things that is, that you just kind of, you know, this is my job and I don't make the system, but this is the way the system is operating and you just, you know, but it does take a toll on you. So, okay, Tullisha had a slightly above average vulnerability score of 120. She hadn't checked enough boxes to get a higher score.

She didn't check things like have you ever been convicted of methamphetamine production or arson or do you have an excessive dependency on drugs or alcohol? And in the system we have now, those things actually help you move to the top of the list because they're thought of as indicators that it's going to be hard for you to get into housing on your own. People with those kinds of issues are more likely to stay homeless if no one intervenes.

So that makes some sense, right? But a system that in a way rewards things like addiction or criminal record, it's going to be controversial to some people. Everybody has their own opinion about who should be prioritized, who shouldn't. And then you hear a lot of conversation about who's deserving, who's not deserving. Again, Julie Ledbetter, who helped build this system in Alameda County. It's manifested a lot in terms of like that drug user doesn't deserve it.

Why are they getting prioritized? It's wild when you think about how far things are from when Samsung bearers started housing first. The way it looked pre-housing first was that only people who are clean and mentally sound enough to navigate the system, God housing. Now is the opposite. Now the more of these kinds of barriers and vulnerabilities you have, the more likely you are to get help.

HUD and as a result, all of the local communities it funds have decided to focus on this group for reasons both moral and financial. This group really is more likely to die on the street if they don't come inside. And also they're the most likely to cost the government money if they stay outside. But and stay with me me here, prioritizing this group, whatever the reason. It's had an unintended consequence in some communities. It can actually end up favoring white people. One of my and other people's concerns have been that because there's so much structural racism, it is much easier to become homeless if you're black. This is Margot Coushell.

She's a doctor and a researcher on homelessness at the University of California, San Francisco. So what we see if you just look within the homeless population, the black folks look healthier because to be homeless in black means you could just be poor. And in general, this is a sweeping generalization, but in general, more a higher proportion of the white folks who are homeless have these disabilities that are related to their homelessness, not everyone, of course, but you're more likely.

I want to jump in here because I think this is tricky to understand, but important. So okay, think about it like this. A white person is standing on a diving board, and homelessness is what happens if they fall over the edge. But it's a long diving board with plenty of space. Every personal difficulty is a push toward the edge. An injury on the job, a little push, the onset of depression, a push, an addiction, another push. By the time this white person gets to the edge and finally falls into homelessness, they may have accumulated a lot of

pushes. You can think of these as vulnerabilities. On the other hand, people of color, and especially black people, because of the racial wealth gap and other disparities caused by systemic racism, they just often have a shorter diving board to begin with, which means one little push might send a black person over the edge. So there are just more relatively healthy black people who fall into homelessness. And this matter is when it comes to the coordinated entry system because the system gives people a higher score if they've accumulated more vulnerabilities like addiction, mental illness, etc. And so what people who have interrogated this have found, and this is true in many places across the country, is that the white folks are more likely to get resources just because they score higher because these scoring systems are all based on individual vulnerability.

Alameda County, I should say, has actually worked to address this issue by adding different kinds of questions to their assessment. And white people are not currently getting resources at a higher rate than people of color. But these issues with the assessment are still a problem in other places across the US. And I feel like what we can see from this is that it's hard to find a framework for vulnerability that fits everyone. Like, where does this framework, which focuses so much on things like mental illness and

addiction, where does it leave Tilecia's son Jordan, an 11 year old kid who doesn't have those particular issues, but is vulnerable in so many different ways? So okay, the assessment process isn't perfect, but the biggest problem, the biggest problem isn't that figuring out who the most vulnerable people are is tricky. It's that in Alameda County, there are 8,000 people on the list and the vast majority of them will get nothing. Not to mention all of the people

who never even make it onto the list to begin with, because they aren't considered literally homeless. And those people who don't get any help from the system or who don't even get to enter the system, they don't just disappear. Some of them will find their way back into housing, but many of them won't. And eventually, some folks will end up in more vulnerable

and often more visible forms of homelessness. People who start out on a friend's couch may end up in a car, but then the car gets towed and they end up in a tent by the side of the road. Along the way, they accumulate trauma. They get injured or assaulted or have mental health crises brought on by stress. Eventually, there are more and more people who can check a lot of those boxes on the vulnerability assessment.

And there's not even enough resources for all of them. That's what's already happening right now in Alameda County. The system is just completely overwhelmed. The pressure on the system to do well, and to be good, and to be efficient, and to be clear just feels like a burden. I mean, we're all just experiencing this as we just want to be the best you can be in the time of crisis, and you know,

you're not quite there yet, you know? And they have to just keep working on it. People will keep trying to make this whole thing run more smoothly. They'll try to make it as fair as possible. But the thing is, no matter how much you work on the system, if you're trying to feed 8,000 people with 2,000 sandwiches. That math is just never going to work out. And people like Julie, who work in this system, who helped build it, they know this. They certainly don't need me a reporter to point it out.

They feel the system's deficiencies all the time, and it's hard on them. It wasn't until the end of my interview with Julie, as I was getting up to leave, that I realized just how hard. Well, thank you. It's great. I don't know if lots of people cry out there these days, but it is tough. Oh, man. And it's not tough for me. I sit here, but I just think about all those frontline people in the world. It's like feeling it these days. I mean, everyone on the streets, all the workers who are doing the assessment, you know,

like everybody. It's just an incredibly brutal time these days. And everyone out there is feeling this pressure to do more. And people are doing a lot. People are really doing a lot. And there's just a lot more to be done. It's not just Julie. So many of the people I talk to who work in this system have the sense that they are being asked to solve this problem without having been given the resources to do it. Like Roshana from 2-1-1.

She told me the main thing she understands now about homelessness, that she didn't understand before the job. Is that for most people out there, there is no help. What are they getting? Nothing. Sit back in a circle to call to one one and cuss us out and say, you guys aren't doing, you know, this and that for me. And we take it. We're the emergency room for the community. We take it.

But it's like, we share our frustrations. Like, we don't like telling people we don't have these resources. Every person I'm at working in the different corners of this system wanted there to be more resources. And local communities like Alameda County are always scrambling to find new revenue sources since they don't get anywhere near enough funding from HUD. Ballot initiative, sales taxes, state funds. And if we wanna help the people who are homeless right now, we will need this system to have all of the resources it requires to do that.

But that won't actually solve the bigger problem because this system just wasn't designed to do that. When homelessness started exploding in the 1980s, people didn't understand what was happening. We blamed it on the institutionalization and crack. Homelessness was something that happened to people who weren't well, and we created a system to respond to the people who seemed the least well, the least capable of solving their own homelessness, the most vulnerable we call them.

But increasingly experts agree that homelessness isn't caused by mental illness or addiction. Those things can serve as the catalyst, but they aren't the cause. The cause is economic. If people can't afford housing, making minimum wage or can afford housing, if they're on social security or disability. You're just going to have homelessness, which is why it feels clear to me after all of this, that the homeless service system cannot solve homelessness. And I guess if the journey into understanding this system has been like opening a set

of Russian nesting dolls, this is the one at the center. This system can't solve homelessness, it can only address it. It can treat the symptoms, but not the disease. And currently, it's not even treating the symptoms all that well. We are still talking about homelessness, like it's about the people on the street today. It's unbelievable to make you know. You may recognize that voice, it's Sam's embarrassed. But that was like, how do we get these homeless people off the street? What do we do with these homeless people?

I mean, these are just the current victims of a system that's creating homelessness much faster than we are ending it. So it's like even if you took this 60 or 80,000 people that are on the streets right now and house them, you haven't ended homelessness because next year you're going to have 20 in the year after 40 and 60. In some ways it was Sam's work with the most vulnerable that led to the system we have now, which focuses only on them. But Sam thinks that if we're really gonna solve homelessness,

we're gonna have to prevent people from ending up homeless in the first place by making sure that extremely low income folks have access to housing they can afford. That's what we had before the 80s. Sam wants that back. Not the way it was then with poor people sequestered in ghettos, but mixed income development on a massive scale. Where's the plan to build 80,000 units of affordable housing? Everyone talks about, oh, we'll do

200 units a year. So we just got 400 units. It's like, so what? I mean, not really so what, but it's like, but so what. Sam gets so worked up when he talks about all of this. He's infuriated that as a society, we don't invest in truly fixing this problem. We just do these half measures and then wonder why they haven't worked. Instead of doing what really needs to be done, we've built a whole system, a whole industry around addressing homelessness for a very, very small number of people.

But Sam still works inside this system, and when I ask him why he hasn't just given up on it completely, he says it's because it's still worth it. It still matters to house even just one person. On the last episode of According to Need, one person finally actually get something from this system. Well, what else is going on in your world right now, Sam? Nothing else is going on in my world, Katie. This is my world. I live in breathe, you know, homelessness. And then I try and go to walks to stop thinking about it for a little bit. After the break, a preview of our final episode coming up on according to need.

Why is it raining? Screw the tent. Hey, hi. We don't want to break the law, but we have to live somebody's and have to sleep for them just like I need to live. Now you won't help Casey get water. You want me to do it, as I'm digging a ditch to save her tent. I was trying to figure out the situation in which you might use your escape hatch. I don't know. I really know him.

He's just like knowing it's there. Yeah, like knowing he's there. It's really hard to find a decent place in Berkeley with a voucher. If you do find a place in Berkeley with a voucher, they tend not to be the nicest places. You know, they're renting not apartments, they're not bedrooms, beds, for 1200 a month in the college. That's outrageous. And did she tell you when you could expect to hear anything? She said, you know where I stood on the list by Tuesday or Wednesday, so.

Getting to the top of the list is just the beginning. What it looks like to actually get help from the system. That's next time on According to Need. This chapter of According to Need was produced by me, Katie Mingle with Associate Producer Abby Medon and Managing Editor Whitney Henry Lester. Huge thanks to Anna Liva, Jami Almanza, Dennis Cullhain, Allison D. Young, Regina Cannon,

Jesse Shimon, Ocean Newman, and E. N. D. Young, who all spent time talking to me about the list. Roman Mars is the Executive Producer of According to Need. Invaluable editing from Lisa Pollock, Emmett Fitzgerald, Delaney Hall, Christopher Johnson, Joe Rosenberg, and Roman Mars. Bryson Barnes was our sound engineer, fact checking by Amy Gaines, beautiful music by the beautiful Sean Raal, branding and design by muchmore.io. Kurt Colstead was our digital director, additional support from Sofia Klatsker, Vivian Leigh, and Chris Berrubay. Special thanks to Marie Solmindina-Karena, Johanna Zorn, and Chelsea Miller.

According to Need is a project of 99% invisible, which is a founding proud member of Radio Topia from PRX, a network of independent listener-supported artist-owned podcasts. Radio Tapio.